
Contents
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Chapter contents Chapter contents
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Defibrillation Defibrillation
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Quality of CPR Quality of CPR
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Strategies before defibrillation Strategies before defibrillation
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Safe use of oxygen during defibrillation Safe use of oxygen during defibrillation
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The technique for electrode contact with the chest The technique for electrode contact with the chest
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CPR vs defibrillation as the initial treatment CPR vs defibrillation as the initial treatment
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One-shock vs three-shock sequence One-shock vs three-shock sequence
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Waveforms and energy levels Waveforms and energy levels
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Manual defibrillation Manual defibrillation
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Cardioversion Cardioversion
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Atrial fibrillation Atrial fibrillation
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Atrial flutter and paroxysmal supraventricular tachycardia Atrial flutter and paroxysmal supraventricular tachycardia
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Ventricular tachycardia Ventricular tachycardia
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Further reading Further reading
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Temporary cardiac pacing Temporary cardiac pacing
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Indications for temporary cardiac pacing Indications for temporary cardiac pacing
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The setting of an acute myocardial infarction (AMI) The setting of an acute myocardial infarction (AMI)
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Not related to an AMI Not related to an AMI
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Overdrive suppression of tachyarrhythmias Overdrive suppression of tachyarrhythmias
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Prophylactic temporary cardiac pacing Prophylactic temporary cardiac pacing
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Types of temporary cardiac pacing Types of temporary cardiac pacing
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Temporary transcutaneous cardiac pacing Temporary transcutaneous cardiac pacing
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Temporary transvenous cardiac pacing Temporary transvenous cardiac pacing
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The procedure The procedure
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Complications of transvenous pacing Complications of transvenous pacing
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Temporary transoesophageal cardiac pacing Temporary transoesophageal cardiac pacing
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Temporary epicardial cardiac pacing Temporary epicardial cardiac pacing
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Setting the pacemaker up Setting the pacemaker up
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Determine the capture threshold Determine the capture threshold
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Determine the sensitivity threshold Determine the sensitivity threshold
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Pacemaker mode and variables Pacemaker mode and variables
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Caring for patients with pacemakers Caring for patients with pacemakers
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Troubleshooting Troubleshooting
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The absence of pacing spikes on the ECG The absence of pacing spikes on the ECG
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Failure to pace Failure to pace
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Failure to capture Failure to capture
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Failure to sense or undersensing Failure to sense or undersensing
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Inappropriate or oversensing Inappropriate or oversensing
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Causes of failure to pace, capture or sense Causes of failure to pace, capture or sense
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Futher reading Futher reading
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Intra-aortic balloon counterpulsation pump Intra-aortic balloon counterpulsation pump
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Physiology Physiology
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ECG signal ECG signal
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Arterial waveform Arterial waveform
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Errors in timing Errors in timing
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Indications Indications
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Contraindications Contraindications
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Insertion of the balloon pump Insertion of the balloon pump
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Complications Complications
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Vascular Vascular
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Balloon related Balloon related
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Other Other
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Removal of the balloon pump Removal of the balloon pump
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Further reading Further reading
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Cardiac assist devices Cardiac assist devices
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General description General description
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Indications for cardiac assist device Indications for cardiac assist device
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Contraindications to VAD support Contraindications to VAD support
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Types of pump Types of pump
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Pulsatile Pulsatile
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Pneumatic Pneumatic
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Electric motor driven Electric motor driven
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Non-pulsatile Non-pulsatile
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Centrifugal Centrifugal
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Axial Axial
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Complications associated with VADs Complications associated with VADs
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Total artificial hearts Total artificial hearts
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Catheter-based temporary assist devices Catheter-based temporary assist devices
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Impella Impella
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Tandem Heart Tandem Heart
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Venoarterial extracorporeal membrane oxygenation Venoarterial extracorporeal membrane oxygenation
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Uses of VA ECMO Uses of VA ECMO
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Further reading Further reading
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Therapeutic cooling Therapeutic cooling
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Definitions Definitions
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Induction phase Induction phase
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Maintenance phase Maintenance phase
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Re-warming phase Re-warming phase
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Practical aspects Practical aspects
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Precautions Precautions
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Cooling methods Cooling methods
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Controlled normothermia Controlled normothermia
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Conclusions Conclusions
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Further reading Further reading
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Cite
Extract
Chapter contents
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Defibrillation
Defibrillation is the delivery of sufficient electrical current to depolarize a critical mass of myocardium and enable restoration of coordinated electrical activity. All defibrillators have three features in common:
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Defibrillation is defined as the termination of fibrillation or, more precisely, the absence of ventricular fibrillation/ventricular tachycardia (VF/VT) at 5s after shock delivery; however, the goal of attempted defibrillation is to restore spontaneous circulation.
Defibrillation is a key link in the chain of survival and is one of the few interventions that have been shown to improve outcome from VF/VT cardiac arrest. The likelihood of successful defibrillation diminishes rapidly with any delay in shock delivery. Automated external defibrillators (AEDs) have microprocessors that analyse several features of the ECG, including frequency and amplitude—the user does not need to be able to interpret the ECG. Manual defibrillators rely on the user interpreting the rhythm and determining if a shock is appropriate.
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