Defibrillation (Internal Medicine)

• Ventricular fibrillation (VF)
• Pulseless ventricular tachycardia (VT)
• Hemodynamically unstable polymorphic ventricular tachycardia.

• Advanced directive, Do Not Resuscitate order
• Resuscitation should not be initiated if signs of death are present.
• Defibrillation is not indicated if a rhythm that is not responsive to defibrillation is present.

• ECG monitor/defibrillator
  • Paddles and pads
  • Conductive materials
• Automated external defibrillator
• Resuscitation supplies (adjuncts to defibrillation)
• Intravenous access (see Intravenous Cannulation for further details)
• Advanced airway management equipment (see Basic Airway Management for further details)
• Resuscitation/antidysrhythmic drugs

• The heart lies behind the sternum, with the base at about the third intercostal space just to the right of the sternum and the apex in the fifth intercostal space, inferior to the nipple and usually just medial to the nipple.
• Anteroposterior placement (for self-adhesive defibrillator electrode pads)
  • Anterior pad: just to the left of the sternum at the point of maximum impact (PMI).
  • Posterior pad: to the left of the spine, just below the left scapula
• Anterolateral placement (for pads or paddles)
  • Left lateral pad: left fourth or fifth intercostal space, midaxillary line
  • Right anterior pad: to the right of the sternal margin, second or third intercostal space

Figure 1 :  Preparing to defibrillate

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Figure 4 :  ECG monitor / defibrillator

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Figure 10 :  Anatomy and pad placement

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The full content of this section includes:

• Step-by-step text instructions for performing the procedure
  
• Clinical pearls providing practical clinical tips from medical experts
• Patient safety guidelines consistent with Joint Commission and OHSA standards
• Links to medical evidence and related procedures

Figure 13 :  Select the energy output

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Figure 14 :  Charge the defibrillator

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Figure 15 :  Deliver the shock

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Table 1 :  Energy output settings for defibrillation

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• If VF or pulseless VT persists, continue CPR and proceed according to the ACLS Pulseless Arrest — Ventricular Fibrillation guidelines.¹
• Treat underlying causes of the ventricular arrhythmia (e.g., myocardial infarction, trauma).
• Manage any complications of resuscitation (e.g., rib fracture, pneumothorax).

• Permanent cardiac pacemaker or automatic implantable cardioverter-defibrillator (AICD) dysfunction
• Skin burns
• Injuries to health care personnel