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Many first responders , such as firefighters, policemen, and security guards, are equipped with them. AEDs can be fully automatic or semi-automatic. If a shock is advised, the user must then push a button to administer the shock.
A fully automated AED automatically diagnoses the heart rhythm and advises the user to stand back while the shock is automatically given. These devices are implants, similar to pacemakers and many can also perform the pacemaking function. They constantly monitor the patient's heart rhythm, and automatically administer shocks for various life-threatening arrhythmias, according to the device's programming. Many modern devices can distinguish between ventricular fibrillation , ventricular tachycardia , and more benign arrhythmias like supraventricular tachycardia and atrial fibrillation.
Some devices may attempt overdrive pacing prior to synchronised cardioversion. When the life-threatening arrhythmia is ventricular fibrillation, the device is programmed to proceed immediately to an unsynchronized shock. There are cases where the patient's ICD may fire constantly or inappropriately.
This is considered a medical emergency , as it depletes the device's battery life, causes significant discomfort and anxiety to the patient, and in some cases may actually trigger life-threatening arrhythmias. Some emergency medical services personnel are now equipped with a ring magnet to place over the device, which effectively disables the shock function of the device while still allowing the pacemaker to function if the device is so equipped.
If the device is shocking frequently, but appropriately, EMS personnel may administer sedation. Wearable cardioverter defibrillator[ edit ] Main article: wearable cardioverter defibrillator A wearable cardioverter defibrillator is a portable external defibrillator that can be worn by at-risk patients. This device is mainly indicated in patients who are not immediate candidates for ICDs.
The electrodes consist of round metal plates that come in direct contact with the myocardium. Interface with person[ edit ] This section does not cite any sources.
Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. August Learn how and when to remove this template message The connection between the defibrillator and the patient consists of a pair of electrodes, each provided with electrically conductive gel in order to ensure a good connection and to minimize electrical resistance , also called chest impedance despite the DC discharge which would burn the patient.
Gel may be either wet similar in consistency to surgical lubricant or solid similar to gummi candy. Solid-gel is more convenient, because there is no need to clean the used gel off the person's skin after defibrillation.
However, the use of solid-gel presents a higher risk of burns during defibrillation, since wet-gel electrodes more evenly conduct electricity into the body. Paddle electrodes, which were the first type developed, come without gel, and must have the gel applied in a separate step. Self-adhesive electrodes come prefitted with gel.
There is a general division of opinion over which type of electrode is superior in hospital settings; the American Heart Association favors neither, and all modern manual defibrillators used in hospitals allow for swift switching between self-adhesive pads and traditional paddles.
Each type of electrode has its merits and demerits. Paddle electrodes[ edit ] A pair of defibrillator paddles. The most well-known type of electrode widely depicted in films and television is the traditional metal paddle with an insulated usually plastic handle. Paddles offer a few advantages over self-adhesive pads. Many hospitals in the United States continue the use of paddles, with disposable gel pads attached in most cases, due to the inherent speed with which these electrodes can be placed and used.
This is critical during cardiac arrest, as each second of nonperfusion means tissue loss. Modern paddles allow for monitoring electrocardiography , though in hospital situations, separate monitoring leads are often already in place. Paddles are reusable, being cleaned after use and stored for the next patient. Gel is therefore not preapplied, and must be added before these paddles are used on the patient.
Paddles are generally only found on manual external units. Self-adhesive electrodes[ edit ] Newer types of resuscitation electrodes are designed as an adhesive pad, which includes either solid or wet gel.
These are peeled off their backing and applied to the patient's chest when deemed necessary, much the same as any other sticker. The electrodes are then connected to a defibrillator, much as the paddles would be. If defibrillation is required, the machine is charged, and the shock is delivered, without any need to apply any additional gel or to retrieve and place any paddles. Most adhesive electrodes are designed to be used not only for defibrillation, but also for transcutaneous pacing and synchronized electrical cardioversion.
These adhesive pads are found on most automated and semi-automated units and are replacing paddles entirely in non-hospital settings. In hospital, for cases where cardiac arrest is likely to occur but has not yet , self-adhesive pads may be placed prophylactically.
Pads also offer an advantage to the untrained user, and to medics working in the sub-optimal conditions of the field. Pads do not require extra leads to be attached for monitoring, and they do not require any force to be applied as the shock is delivered. Thus, adhesive electrodes minimize the risk of the operator coming into physical and thus electrical contact with the patient as the shock is delivered by allowing the operator to be up to several feet away.
The risk of electrical shock to others remains unchanged, as does that of shock due to operator misuse.
Self-adhesive electrodes are single-use only. They may be used for multiple shocks in a single course of treatment, but are replaced if or in case the patient recovers then reenters cardiac arrest.
Placement[ edit ] Placement of electrodes for defibrillation Resuscitation electrodes are placed according to one of two schemes. The anterior-posterior scheme is the preferred scheme for long-term electrode placement. One electrode is placed over the left precordium the lower part of the chest, in front of the heart.
The other electrode is placed on the back, behind the heart in the region between the scapula. This placement is preferred because it is best for non-invasive pacing. The anterior-apex scheme can be used when the anterior-posterior scheme is inconvenient or unnecessary. In this scheme, the anterior electrode is placed on the right, below the clavicle. The apex electrode is applied to the left side of the patient, just below and to the left of the pectoral muscle.
This scheme works well for defibrillation and cardioversion, as well as for monitoring an ECG. Researchers have created a software modeling system capable of mapping an individual's chest and determining the best position for an external or internal cardiac defibrillator. They discovered that small electrical shocks could induce ventricular fibrillation in dogs, and that larger charges would reverse the condition. Henry Hyman, an electrical engineer, looking for an alternative to injecting powerful drugs directly into the heart, came up with an invention that used an electrical shock in place of drug injection.
This invention was called the Hyman Otor where a hollow needle is used to pass an insulated wire to the heart area to deliver the electrical shock. The hollow steel needle acted as one end of the circuit and the tip of the insulated wire the other end.
Whether the Hyman Otor was a success is unknown. William studied the relation between the electric shocks and its effects on human heart when he was a student at Johns Hopkins University School of Engineering. His studies helped him to invent a device for external jump start of the heart. Beck's theory was that ventricular fibrillation often occurred in hearts which were fundamentally healthy, in his terms "Hearts that are too good to die", and that there must be a way of saving them.
Beck first used the technique successfully on a year-old boy who was being operated on for a congenital chest defect. Successfully reported this slideshow. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
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