Part Three
- Electric shock device
Definition:
It is to give the patient an electric shock on the surface of the heart in order to extinguish the irritated focus, whether in the atrium or ventricle, and it is very effective if used within 15-20 seconds of the onset of arrhythmia ( arrhythmia ).
Purpose of use of the device:-
Used to correct cardiac arrhythmias in the case of :-
-pulseless ventricular tachycardia.
-ventricular fibrilation .
It is possible to say:-
Any arrhythmia is accompanied by an instability of vital signs .
When to use electric shock :-
electric shock is actually used to treat tachycardia (atrial flutter, atrial fibrillation ) along with ventricular fibrillation, which is the most dangerous for life .Where atrial flutter occurs as a result of a circular movement in the electrical signal in the atrium causes the atria to contract very quickly and the amount of blood pumped by the atria is very small because one side of IT contracts and the other relaxes , and the period of atrioventricular node irregularity is long, so only part of the atrial signals pass to the ventricles .
◾ As for atrial fibrillation, it is either caused by atrial hypertrophy caused by problems with the heart valves that prevent the atria from adequately emptying into the ventricles, or caused by ventricular insufficiency with increased blood reservation in the atria .
◾ Knowing that ventricular fibrillation is the most dangerous for life by the passage of cardiac impulses causing small parts of the ventricular muscle to contract while other small parts relax equally, therefore there is no coordinated contraction of the entire myocardium at once and therefore there is no pumping or there is little pumping of blood from the ventricles .
Types of shock apparatus :-
1-a single-charge device.
2-a dual-charge device.
Types of shocks :-
1-Non synchronized or defibrillation.
2-Synchronized or cardioversion.
1- non synchronized or defibrillation
◾ Asynchronous electric shock (means we determine the time of discharge of the charge ) by pressing the discharge of the delivery
◾ High joule and usually for adults.
◾ We start with three consecutive shocks J200, 300 J. 360 J from less to more .. It was returned after CPR work for a minute and the atomizer did not change.
◾ the patient should be given a dose of sedation and analgesic, even if the patient is unconscious, he should be given analgesic at least ..
2- Synchronized or cardio version
◾ A shock synchronized with the beginning of R wave.... We do not specify the discharge time ..We press unload but the machine chooses the right time for unloading
◾ low Joule, sometimes from fifty or MJ
◾ - The patient should be given a dose of sedation and analgesic, even if the patient is unconscious, he should be given analgesic at least ..
◾ One shock is given .. Then the single can be replayed
Indications for use :-
1- non synchronized or defibrillation
pulseless ventricular tachycardia
ventricular fibrillation
2- Synchronized or cardio version
St unstable tachycardia means a group of tachycardia provided that it is accompanied by low blood pressure, namely :-
1. S.V.T
2. V.Tach
3. A.Flutter
4. A.F
5. - But if the pressure is normal, you should start giving medications such as digoxin, adenosine...Isoptin..Cordarone ... When the pressure decreases, simultaneous shocks occur.
1.The main control buttons of the device:-
1. Power the device's power button.
2. Selector switch elector energy in Joules, in order to set the energy required to charge the capacitor, the energy ranges between (9-400) Joules, the field is divided into two parts, one of which is for direct uses on the heart wall (INTERNAL)9-50 Joules because applying a higher voltage leads to damage to the heart, and the remaining field is for external use(EXTERNAL) ..
3. chargeit is used to charge the capacitor.
4. Charge indicator lightindicator indicates that the capacitor has been charged and it is ready for discharge, it is located on the shocker and on the control panel.
5. Discharge a button placed on the paddle presses simultaneously with its counterpart in the second paddle in order to discharge the charge through the patient's chest.
6. Synchronizer synchronizer: in order for the charge discharge to coincide with the ECG signal and specifically with the threshold peak R, the discharge wave is applied after the detection of the waver and at its peak.
7. Leadin order to select quotations I,II, III.
Alarm
8. it gives an audible alarm according to the heart frequency, and gives an alarm in case of exceeding the limits set by the doctor, and this button is used in order to turn on and off this sound.
9. ECG in order to calibrate the length of the ECG signal relative to. cm
Freeze
10. freezes the ECG signal on the screen.
11. Run / Stop: it is used to turn on and off the printer.
12. Mark: puts the existing mark on the printer paper, starts from there and records.
13. High. The upper limits of the heart frequency are changed, and when exceeded, an alarm is issued.
14. Low: the minimum heart frequency limits are changed, and when exceeded, an alarm is issued.
15. battery charge indicator light: gives a light indicating the battery charging process.
Battery precautions:-
◾ This charging capacitor has a specific lifetime, and its lifetime is at least 20,000 shocks.
battery: the battery must always be charged and in order to use it in case of emergency or in an ambulance, the battery charge is achieved by keeping the device plugged into an AC outlet so that the battery remains fully charged, charging the battery to 90% of its capacity is achieved within (2 to 3) hours as an indicator appears on the screen Indicates high battery voltage
◾ If the battery remains uncharged for a period ranging from (4 to 6 ) months , it leads to damage to the battery and then it needs to be replaced, so it must be included among the spare parts .
The fatal mistake that is repeated every day without ..............Sergeant and computer
,,When the ECG shows a ventricular acceleration edema, and the doctor goes to give an asynchronous shock, non-synchronized or defibrillation, before checking the pulse, he treats it as if it were ventricular acceleration without a pulse, but in fact it can be ventricular acceleration with the presence of a pulse, i.e. all two diagnoses are represented by one diagram, ventricular acceleration without a pulse is a fatal diagnosis ,, Ventricular acceleration with a pulse diagnosis is not dangerous once, but after the wrong shock, ventricular acceleration turns from having a pulse to no pulse and kills the patient
,,, Quite simply ,,,
Security and safety procedures
_ Device-specific rentals:
◾ * Total isolation between the inner and outer circle
◾ *Each hoop should have a dump key
◾ * The device has an audio and visual alarm when the device is charged
◾ * There should be an automatic discharge inside the device.
_ Patient safety procedures:
◾ *To protect the patient from burns, a large amount of gel is applied
◾ * Good pressure on the two planes until they stick because moving them allows there to be a gel between two planes and allows an electric current to pass between them and to reach the electric current
◾ * Do not connect the patient to any other device while using the device
Safety measures for the user:
◾ cleaning the Tartine from the gel
◾ not to touch the patient while giving the shock
◾ not to discharge the charge in the air or two adhesions
◾ electroshock device and gel
◾ * cardiopulmonary resuscitation tools
Steps:
◾ * Show the patient's chest
◾ * Start doing cardiopulmonary resuscitation
◾ * 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
◾ The pads are placed on the patient's chest from below the right collarbone and the other in the imaginary line of the middle of the patient's left armpit.
◾ press the shipment button
◾ The allowance is lifted after the shipment is given .