Part Three
- Giving the patient an electric shock
The Definition:
It is giving the patient an electric shock on the surface of the heart in order to suppress the irritated spot, whether it is in the atrium or the ventricle. It is very effective if it is used within 15-20 seconds of the start of the occurrence of Arrythmia (arrhythmia). Thus, the irritated spot is calmed and given an opportunity (Sponde) or The sinoatrial node produces natural charges. The joule or colors are used to measure the amount of natural charges. It begins with the first dose (200 joules), the second dose (200-300 joules), and the third dose (360 joules).
Description of the device and how to operate it:
It is a device that acts as a regular monitor in addition to giving a charge.
As for its operation: - The amount of shock is determined as previously mentioned.
Choose the type of shipment (Synchronized), meaning it comes out with ((R).
It is used in cases:
-Atrial tremor - Atrium tremor
As for the only case in which Non synchronized is used, which is VF, ventricular tremor, and there is no R, a sufficient amount of gel is placed on the Paddels and on the patient’s skin to avoid burning the skin. Also, the Paddels with the word “sternum” written on them should be placed at the sternum on the right side up, below the collarbone. .
As for the paddels labeled Appex, they are located at the apex of the heart, under the nipple of the left chest.
Purpose of using the device
It is used to correct irregular heartbeats
Complete or sudden cessation of the heart muscle
The theory of device operation
The device produces an electric shock
Through two batteries attached to the patient's chest, this shock causes the muscle cells (heart) to contract momentarily. The electric shock is obtained by storing it in a high source capacitor. The charging process continues for several seconds until
an alarm sound is heard, then the capacitor is discharged in the patient's body through the two batteries.
Security and safety measures
1-_Fees for the device:
Total isolation between the inside and outside circles
Each hoop must have an unloading key
The device should contain an audio and visual warning when the device is charging
There should be automatic emptying inside the device
2-_Safety procedures for the patient:
To protect the patient from burns, a large amount of gel is applied
Put good pressure on the two frames until they stick, because moving them allows the presence of gel between two frames and allows an electric current to pass between them, but the electric current does not reach them.
Do not connect the patient to any other device while using the device
3-_Safety measures for the user:
Clean the two frames from the gel
Do not touch the patient while giving the shock
Do not discharge the charge into the air or stick together
Electroshock device and gel
Cardiopulmonary resuscitation tools
Steps:
Show the patient's chest
Start performing CPR
Apply the gel on the pads and on the patient's skin to avoid burns
The shipment is adjusted according to the doctor’s orders
Paddles are placed on the sternum on the upper side, below the collarbone on the right side
(Apex) (pads) are placed.
Click on the shipment button
The paddles are raised after giving the load. Types of shocks, two types,,,
non synchronized or defibrillation
Synchronized or cardioversion
The differences between them
non synchronized or defibrillation
Asynchronous electric shock (1) This means that we set a time by pressing the electric charge discharge button (deliver).
We start with three successive shocks: 200 J, 300 J. 360 J 2, from least to most... and they are repeated after doing CPR for a minute until the sputum changes.
As for Synchronized or cardioversion
A shock synchronized with the start of the wave.... 1 We do not specify the discharge time. We click on discharge, but the device chooses the appropriate time.
Low joule,,, sometimes from fifty or a hundred joules 2
The patient should be given a sedative - a shock should be given. One shock should be given
· Causes of non-synchronized shock.. Non synchronized
1- Pulse ventricular tachycardia
2- Ventricular fibrillation
Causes of synchronized shock
Tachycardia refers to a group of irregular heartbeats provided that they are accompanied by a decrease in blood pressure. These are:
1-Atrial fibrillation <<<< AF
2-ventricular tachycardia
3- supra ventricular tachycardia <<< SVT
If the pressure is normal, you must start giving medications such as digoxin, adenosine, Isoptin, Cordarone... and when the pressure drops as a result of simultaneous shocks.
The fatal mistake, which is repeated daily without supervision or control, is when the ECG shows ventricular tachycardia (VT) and the doctor decides to administer a non-synchronized shock, which is non-synchronized or defibrillation.
Before he checked for a pulse, he treated it as if it was ventricular tachycardia without a pulse, but in reality it could be ventricular tachycardia with a pulse,, meaning both diagnoses are represented by one diagram.
Ventricular tachycardia registers a fatal diagnostic pulse, and ventricular tachycardia with a diagnostic pulse is not dangerous at all times, but after the wrong shock, we change the ventricular tachycardia from the presence of a pulse to the absence of a pulse and kill the patient.
Al-Monitor
The Definition:
The medical monitor device is an electronic medical tool used for medical observation, and physiological data is constantly shown on the screen of this device.
Types:
Analog note devices:
It was previously used, as the device only showed the EKG, and after special modifications were made to it, there became a monitor device that measured blood pressure and another device for measuring the pulse. These devices were widely used and helped save the lives of many people, but there were many obstacles in their way, such as Electrical interference, lack of alarms, and being expensive.
Digital note devices:
With the presence of digital signal processing technology, medical monitors have developed significantly. All models have become digital and have the advantage of miniaturization and portability. Their standards include pulse oximeter, blood oxygen meter, blood pressure, temperature, and electronic cardiogram.
Monitoring devices attached to the pacemaker:
These devices are often used in the reception and emergency units, in order to save time and effort in transferring the patient from one device to another.
Uses:
Measurement of vital signs
1. EKG
2. Measuring blood pressure using a pressure piece that is wrapped around the patient’s arms. Normal blood pressure is 12080±20
3. Measuring temperature using temperature converters
4. The normal temperature is from 36.5 to 37.5
1. Measuring the level of oxygen in the blood.
Most used individuals:
- Critical care unit patients.
- Dialysis unit patients.
- Operating room patients.
- Recovery room patients.
- Patients in reception units until they are classified.
- Patients of children in the neonatal critical care unit.