Defibrillation is performed by applying an electrical shock to the heart to restore a normal rhythm. The basic steps include pad placement, selecting the appropriate energy level, charging the defibrillator, and delivering the shock.
Understanding Defibrillation Pad Placement
Proper pad placement is essential for effective defibrillation. The typical placement involves:
- Anterior-Lateral Position:
- One pad is placed on the right side of the chest, just below the collarbone.
- The other pad is placed on the left side, below the nipple and medial to the anterior axillary line, around the fifth or sixth intercostal space. (Reference: Video How to do Defibrillation in an Adult | Merck Manual Professional Version)
- Anterior-Posterior Position (Less Common):
- One pad is placed on the anterior chest, and the other on the back, near the heart area.
Steps for Defibrillation
Here is a more detailed breakdown:
- Preparation:
- Ensure the patient is on a dry surface.
- Expose the patient's chest area.
- Apply the defibrillator pads to the chest. Ensure they make good contact with the skin.
- Defibrillator Setup:
- Turn on the defibrillator.
- Select the appropriate energy level. For adults, the typical initial dose is 120-200 joules for a biphasic defibrillator, while monophasic defibrillators start higher, but you always follow the device instructions.
- Charging:
- Press the charge button on the defibrillator.
- Wait until the defibrillator is fully charged and ready to deliver the shock.
- Clear the Area:
- Verbally announce, "I'm clear, you're clear, everybody clear." Ensure that no one is touching the patient or the bed.
- Shock Delivery:
- Press the shock button.
- The defibrillator will deliver the electrical current.
- Post-Shock Assessment:
- After the shock, immediately check the patient's rhythm.
- If the rhythm is not normal, continue following your protocols. Often, this means another shock, CPR, or medications.
Key Considerations:
- Pad Contact: Good pad contact is essential for effective defibrillation. If the patient's chest is hairy, quickly shave the area where the pads will be placed. If the patient is diaphoretic or damp, quickly dry them before applying the pads.
- Energy Levels: Follow the device's manufacturer's recommendations for energy levels.
- Safety: Always ensure everyone is clear of the patient before delivering a shock to prevent injury.
| Step | Description |
|---|---|
| 1. Pad Placement | Place pads correctly on the patient's chest: right of sternum and left below the nipple at mid axillary line. |
| 2. Turn On | Turn on the defibrillator. |
| 3. Select Energy Level | Choose an appropriate energy level. |
| 4. Charge the Device | Press the charge button and wait until fully charged. |
| 5. Clear Area | Confirm no one is touching the patient. |
| 6. Deliver Shock | Press the shock button. |
| 7. Post-Shock Assess | Check the patient's rhythm and follow any additional protocols. |
