Defibrillation is the definitive treatment for the life-threatening cardiac arrhythmias, ventricular fibrillation and ventricular tachycardia.

Defibrillation consists of delivering a therapeutic dose of

electrical energy to the affected heart with a device called a defibrillator. This depolarizes a critical mass of the heart muscle, terminates the arrhythmia, and allows normal sinus rhythm to be
reestablished by the body's natural pacemaker, in the sinoatrial node of the heart.

Defibrillators can be external, transvenous, or implanted, depending on the type of device used or needed. Some external units, known as automated external defibrillators (AEDs), automate the
diagnosis of treatable rhythms, meaning that lay responders or bystanders are able to use them successfully with little, or in some cases no training at all.

Types
2.1 Manual external defibrillator
2.2 Manual internal defibrillator
2.3 Automated external defibrillator (AED)
2.4 Semi-automated external defibrillators
2.5 Implantable Cardioverter-defibrillator (ICD)
2.6 Wearable Cardiac Defibrillator

Placement

Resuscitation electrodes are placed according to one of two schemes. The anterior-posterior scheme (conf. image) 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.

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In medicine, a wound is a type of injury in which skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound). In pathology, it specifically refers
to a sharp injury which damages the dermis of the skin.

Types of wounds

1.) Open

Open wounds can be classified according to the object that caused the wound. The types of open wound are:

• Incisions or incised wounds, caused by a clean, sharp-edged object such as a knife, a razor or a glass splinter.
• Lacerations, irregular tear-like wounds caused by some blunt trauma. The term laceration is commonly misused in reference to incisions.
 • Abrasions (grazes), superficial wounds in which the topmost layer of the skin (the epidermis) is scraped off. Abrasions are often caused by a sliding fall onto a rough surface.
• Puncture wounds, caused by an object puncturing the skin, such as a nail or needle.
• Penetration wounds, caused by an object such as a knife entering the body.
• Gunshot wounds, caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit, such is generally
known as a through-and-through.

2.) Closed

Closed wounds have fewer categories, but are just as dangerous as open wounds. The types of closed wounds are:

• Contusions, more commonly known as bruises, caused by blunt force trauma that damages tissue under the skin.
• Hematomas, also called blood tumors, caused by damage to a blood vessel that in turn causes blood to collect under the skin.
• Crushing injuries, caused by a great or extreme amount of force applied over a long period of time.

Treatment

Treatment of recent lacerations involves examination, cleaning, and closing the wound. If the laceration occurred some time ago it may be allowed to heal by secondary intention due to the high rate
of infection with primary closure.

1.) Cleaning

For simple lacerations cleaning can be accomplished using a number of different solution including: tap water, sterile normal saline, or an antiseptic solution. Tap water has been found to be as good
as, or better than, sterile saline. Tap water is less expensive, can be done by the patient themselves, and leads to equally low rates of infection.

2.) Closure

If closure of a wound is decided upon a number of techniques can be used. These include Steri strips, a Cyanoacrylate glue, staples, and sutures.Absorbable sutures have the benefit over non
absorable sutures of not requiring removal. They are often preferred in children.

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An endotracheal tube (also called an ET tube or ETT) is used in general anaesthesia, intensive care and emergency medicine for airway management and mechanical ventilation. The tube is inserted
into a patient's trachea in order to ensure that the airway is not closed off and that air is able to reach the lungs. The endotracheal tube is regarded as the most reliable available method for protecting
a patient's airway.
atropine sulfate IM,ampule MOA-anesthetic form I-↓ HR, CI-Tachycardia AR-drowsiness, HPN, NR- HR, MIO, void
(Medazolam) (↓salivation), ↓ HR edema before giving
Symptomatic
Class:Anticholinergic Decreases action of the bradycardia
parasympathetic nervous
system increasing
conduction velocity and
heart rate
Clonidine (Catapress) sublingual ↓HR,BP Renal HPN Use cautiously in Wt. gain, dizziness, BP,PR
patients with recent MI fatigue, constipation
-Anti-HPN
Epinephrine (Adrenaline) Ampule, ET tube Relaxes bronchial smooth Anaphylaxis, asthma In labor, shock, Nervousness, tremor, n/v PR. weigh , caustion:w/
muscle arrhythmias emphysema
-Adrenergic
Diazepam (Valium) Capsules, Injection, OS, depresses the CNS Anxiety pregnant women Drowsiness, apnea avoid activities that
Rectal gel twin packs, require alertness
-anticonvulsant, sedative Tablets
Paracetamol IV (>40), suppository reduces fever and pain Pain, fever, ↑ temp, chill severe liver diseases Anemia, rash, n/v Don’t use > 3 days
(acetaminophen) (250m infant, 500 adult)
30 sec to melt, ampule
Analgesic, antipyretic
Lidocaine hcl (xylocaine IM, ET tube, IV, Prior to surgery, VF, MI temporary fix for tinnitus Caution: 2nd °♥ block Restlessness, seizure, Deltoid muscle ONLY,
2%) lidocaine drip + D5 h2O vomiting, nervousness isoenzyme (↑Ck level),
(slowly) BP
Anti arrhythmia
2-5 mg/dl
Mannitol (Osmitrol) IV (5,10,15,20,25%) ↑osmotic pressure, Oliguria, ARF, ↓ICF Anuria, severe Blurred vision, n/v, VS, use urinary cath,
↑water flow, pulmonary diarrhea freq mouth care, use in
Osmotic diuretic X electrolyte ↑extracellular chemo,MIO
NaCO3 (baking soda) Oral,IV (too slow coz of neutralizes excess acid. Metabolic acidosis, Metabolic alkalosis Gastric distention, Give w/o milk
irritation) withdraw cardiac arrest flatulence, irritation
Antacid/alkalinizer NSS10cc 2x.

DON’T give plain (dilute

in h2O)
Furosemide (Lasix) IM,IV,oral Inhibit reabsorbtion of Edema, nephrotic hepatic cirrhosis, severe Restlessness, BP, ,DHN, MIO elevate
Na syndrome, HPN renal ds. thrombophlebitis position, limit fld. intake
diuretic
Albuterol sulfate Capsules/sol for Improve ventilation, relax Acute bronchospasm HPN, DM, GI narrowing Insomnia, tremor, HPN, >1x= (2 min interval),
/Salbutamol (ventoiln) inhalation , Syrup, bronchial & uterine dizziness place mouthpiece, RR
Tablets, nebulize (15 min smooth muscle
adrenergic interval) ampule 1 ml = ↑
RR
Dipenhydramine Block effect of histamine Seasonal allergic rhinitis Peptic ulcer, preg Sedation, dizziness w/ meal, report irreg HR
(benadryl)

Anti-histamine, sedative-
hypnotic, cough
supressants, anti motion
sickness
Tranexamic (Hemostan) Inhibit plasmin activity Mngt. hemophilic pt. ,tx epistaxis, hemorrhage Diarrhea, n/v, DPT, color Check vision after
hereditary edema vision, admn., report DOB
Anti-fibronulitic
s/s:bleeding: pain, ↓BP,
poor cap refill