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Prevent burns, shocks, and other hazards by following these guidelines.

SUDDEN CARDIAC ARREST can happen to any patient, in any unit, any time. Although prompt defibrillation improves the odds of patient's survival, it carries risks, including fire, shocks to caregivers, and patient burns. No matter where you work, make sure you know the location of a defibrillator and how to use it correctly to keep patients, colleagues, and yourself safe.

Restoring the rhythm

Defibrillation is used to treat ventricular fibrillation (VF) and pulseless ventricular tachycardia via a transcutaneous electrical charge that depolarizes the myocardium. This rapid depolarization lets the heart's intrinsic pacemaker (the sinoatrial node) take over, correcting the errant electrical activity.
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During defibrillation, the electric current discharges without regard to the cardiac cycle. In contrast, synchronized electrical cardioversion, which is used to treat nonlethal arrhythmias such as atrial fibrillation, discharges the electric current at the peak of the QRS complex's R wave. You can accomplish this by setting the defibrillator on the synchronized mode. The intent of both procedures is the same-to return the patient's heart to normal sinus rhythm-but synchronization aims to avoid discharging electric current during the vulnerable period of the cardiac cycle, which could cause the R-on-T phenomenon and worsen the arrhythmia.
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Defibrillator safety basics fall into three broad areas. Let's take a look at each.

Make sure the equipment's in order

At least once each day, and after each time you use the defibrillator, inspect it and its paddles, cables, and cord. Make sure all necessary supplies are available for the next time it's needed. (Keep a checklist for this task.) Follow the manufacturer's guidelines for charging and discharging the defibrillator. Never discharge the electric current by placing the paddles together or discharging them into the air, which could cause a fire or explosion.
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Examine the cord and plug for bent electrical prongs, an absent ground prong, or cracks or tears in the cord's surface. The plug and cord can be damaged by being improperly removed from the electrical outlet (always pull by holding the plug, not the cord), being run over with equipment, or from age and the stress of use. If you spot any problems with the cord or plug, notify the biomedical engineering department immediately, take the equipment out of service, and obtain a replacement defibrillator.

Inspect the paddle surfaces for pits and imperfections. If the paddle surface isn't smooth and unblemished, the electric current could leak around the paddle and cause sparks, increasing the risk of explosion or fire during defibrillation and reducing the effectiveness of electrical therapy.
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Also inspect the cables used for cardiac monitoring and the connectors to the defibrillator paddles. Look for damage and make sure connectors fit snugly into the defibrillator ports.

If someone drops the defibrillator (for example, while transporting a patient), have the biomedical engineering department inspect it for cracks in the case or damage to internal components that could cause electrical hazards.

Keep your patient safe

To deliver safe and effective electrical therapy, you'll need to use a conductive agent (such as gel or a conductor pad) and place the defibrillator paddles properly on the patient. If you're performing synchronized electrical cardioversion, you'll also need to be prepared to intervene if the patient's cardiac rhythm deteriorates to a lethal rhythm requiring defibrillation.
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Many models of automated external defibrillators and other defibrillators use biphasic waveform technology, which delivers electrical therapy at lower current levels than the traditional monophasic waveform technology. Because of the lower current levels, biphasic defibrillation is less likely to burn the patient's skin.

Conductive agents, such as defibrillation gel, paste, conductor pads for handheld paddles, and remote defibrillator pads, decrease transthoracic resistance to current flow during electrical therapy.
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If you're applying gel or paste to the defibrillator paddles, use a thin layer; an excess leaking around the paddles onto the patient's chest increases the risk of burns and may cause current to arc between the paddles. Make sure gel from one paddle doesn't pool into gel from the second paddle. If the electric current follows this low-resistance pathway through the gel, it will miss the heart.

Remove any transdermal medication patches from the patient's chest and wipe the area clean before defibrillation. Placing a defibrillation pad over a transdermal patch can also reduce the effectiveness of electrical therapy.

Defibrillator paddles can be placed in several positions, but the anterior-apex position is most common (see Placing Defibrillator Paddles Properly). Use the anterior-posterior position for a patient with an implantable cardioverter-defibrillator (ICD) if defibrillation of up to 360 joules isn't successful with the paddles in the anterior-apex position.

Nursing, Nov 2003 by Cook, Linda


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