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DEFIBRILLATION,
CARDIOVERSION AND
PACING
By: dr ismah, A&E department
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2
3
4
5
6
Defibrillation
History
1900 defibrillation discovery
1947 human defibrillation
1967 successful outside hospital defibrill...
Types
8
http://www.resuscitationcentral.com/
360J 200J
9
Sternum
Apex
10
Automated AED @ KLIA
11
12
Cardioversion
Alive, unstable, tachyarrhythmia
Unstable?
- Signs of low cardiac output: systolic hypotension
< 90 mmHg, ...
Conditions Starting J
(monophasic)
AF 200
Atrial flutter 100
VT 200
SVT 100
14
15
16
Defibrillation Cardioversion
17
Pacing
Unstable, bradyarrhythmias/bradycardia
Symptomatic sinus bradycardia
Heart block
- Complete heart block
- Mobitz...
1st degree heart block
Lengthened P-R interval > 0.2 sec (> 5 small
boxes)
Partial AV node block
19
2nd Degree Heart Block
Mobitz Type I 2nd degree AV block
A cycle of progressive lengthening of PR
interval followed by ab...
*Mobitz Type II 2nd Degree Heart Block
Intermittent absence of QRS complex
(non-conducted P wave)
PR interval normal
21
*Complete/ 3rd degree heart block
Variable conduction origins
Lack of synchronization between atria and
ventricles
22
23
24
Take home message
Recognize ECG findings
Indications for defibrillation, cardioversion and
pacing
How to do it
25
Thank you
Ref:
1. Tintinallis Emergency Medicine Manual, 7th Edition
2. AHA ACLS 2010; Electrical therapy
3. Basic and Adv...
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ACLS
Defibrillation
Cardioversion
Pacing

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Defibrillation, cardioversion and pacing

  1. 1. DEFIBRILLATION, CARDIOVERSION AND PACING By: dr ismah, A&E department 1
  2. 2. 2
  3. 3. 3
  4. 4. 4
  5. 5. 5
  6. 6. 6
  7. 7. Defibrillation History 1900 defibrillation discovery 1947 human defibrillation 1967 successful outside hospital defibrillation For VF or pulseless VT Defibrillation (shock success)  termination of VF for at least 5s following shock 7
  8. 8. Types 8 http://www.resuscitationcentral.com/ 360J 200J
  9. 9. 9 Sternum Apex
  10. 10. 10 Automated AED @ KLIA
  11. 11. 11
  12. 12. 12
  13. 13. Cardioversion Alive, unstable, tachyarrhythmia Unstable? - Signs of low cardiac output: systolic hypotension < 90 mmHg, altered mental status - Excessive rates >150/min - Chest pain - Heart failure Synchronized cardioversion is shock delivery that is timed (synchronized) with the QRS complex 13
  14. 14. Conditions Starting J (monophasic) AF 200 Atrial flutter 100 VT 200 SVT 100 14
  15. 15. 15
  16. 16. 16 Defibrillation Cardioversion
  17. 17. 17
  18. 18. Pacing Unstable, bradyarrhythmias/bradycardia Symptomatic sinus bradycardia Heart block - Complete heart block - Mobitz type II 2nd degree heart block Transcutaneous/transvenous pacing 18
  19. 19. 1st degree heart block Lengthened P-R interval > 0.2 sec (> 5 small boxes) Partial AV node block 19
  20. 20. 2nd Degree Heart Block Mobitz Type I 2nd degree AV block A cycle of progressive lengthening of PR interval followed by absence of QRS complex Wenkebach Phenomeno 20
  21. 21. *Mobitz Type II 2nd Degree Heart Block Intermittent absence of QRS complex (non-conducted P wave) PR interval normal 21
  22. 22. *Complete/ 3rd degree heart block Variable conduction origins Lack of synchronization between atria and ventricles 22
  23. 23. 23
  24. 24. 24
  25. 25. Take home message Recognize ECG findings Indications for defibrillation, cardioversion and pacing How to do it 25
  26. 26. Thank you Ref: 1. Tintinallis Emergency Medicine Manual, 7th Edition 2. AHA ACLS 2010; Electrical therapy 3. Basic and Advanced Life Support 2005 by K.S.Chew, emergency department USM 4. ECG Teaching by Dr Effa, cardiologist, Medical faculty UiTM 5. http://www.ecglibrary.com 26
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