Defibrillators

WHO. Defibrillator, External, Automated; Semiautomated. From the

publication: Core Medical Equipment. Geneva, Switzerland, 2011.
 Summary
Quiz Commercial Examples
Clinical Use Preventive
History Maintenance
Specifications Common Problems
Principles of Operation Test Procedures
Block Diagram
 Quiz
1. What is the 2 main clinical cases that require
the use of defibrillator?

2. What are the different types of defibrillator?

3. What is the defibrillator waveform polarity?

4. Does one need to use gel? Why?

 Quiz
5. What kind of paddles can be used?

6. Draw the 2 possible of paddles placement in the case

of external electrodes.

7. Can one use a defibrillator with a patient on a OR

table? Why?

8. What are 2 ways to test a defibrillator

9. What is the most common problem in defibrillators from

the developing world?
 Fibrillation

Cardiac arrest occurs in more than 500,000

people annually in the United States

Atrial fibrillation (AF) is relatively common

and can be well tolerated by the patient
 Fibrillation

Jer5150 (2012) Fibrillation [Image], retrieved from https://commons.wikimedia.org/wiki/File:Ventricular_fibrillation.png

 Ventricular Fibrillation

Ventricular fibrillation (VF) causes the

heart to stop pumping blood immediately
Irreversible brain damage or death after 5
minutes
Most common cause of death
 Clinical Use

Reverse fibrillation of the heart (300 J to 360 J)

[Drawing of defibrillator pads placement] retrieved from www.wikipedia.com

Restoring the hearts normally coordinated

contractions (below 200 J) Requires ECG
History

1899
Physiologists Prevost and Batelli
from University of Geneva used
small electric shocks to induce
ventricular fibrillation in dogs, and
larger charges to reverse the
condition
History

1947
First use on a human by
Claude Beck, professor of
surgery at Case Western
Reserve University
 Specifications

Input
Electrical: ECG
signal

Output PhilippN, (November 2007), Position of

Electrodes during Defibrillation, retrieved
from
https://commons.wikimedia.org/wiki/File:D

Electrical: 3000 V efibrillation_Electrode_Position.jpg

pulse during 10 ms
Electronically
(display)
Principles of Operation

Electric current is
placed through
electrodes:
Directly on the heart -
low current 300 V
AC.
Transthoracically
large area electrodes,
higher current 1000
V AC [Photograph of defribrilator] retrieved from www.wikipedia.com
Types of Defibrillators
Manual defibrillator (most
common in developing world)

Automated external WHO. Defibrillator, External,

Automated; Semiautomated. From the
publication: Core Medical Equipment.

defibrillators
Geneva, Switzerland, 2011.

AED (Home defibrillator)

Implantable defibrillator
Steven Rodriquez (2007), Defibrillator [photograph], retrieved from
https://www.flickr.com/photos/n28ive1/431939091
Output Pulses
Edmark Waveform
Maximum Pulse 7,500 V
Common in the poor world
Severe damage (death)
Be clear of the patient during the discharge
vp
2kv

~10 ms

Virginia Reid (2015), Waveform [drawing]

Output Pulses

Virginia Reid (2015), Output Pulses, [drawing]

Monophasic truncated Biphasic truncated

exponential exponential

Safest Waveform
Manual Defibrillators
ECG
ECG leads can also
be connected from the
device to the patient

However, most can

monitor the ECG
through the Aededitor (2011), Semi-automated external monitor defibrillator [photograph],
retrieved from https://commons.wikimedia.org/wiki/File:Semi-automated-external-
monitor-defibrillator.jpg

defibrillation paddles
as well.
Synchronization
Shock point

Husche (2015), ECG Figure EN [diagram]. Adapted from https://commons.wikimedia.org/wiki/File:CCM_ECG_Figure_EN.png

ECG Synchronization

Anthony Atkielski (2012), Sinus Rhythm Labels [diagram]. Retrieved from https://commons.wikimedia.org/wiki/File:SinusRhythmLabels_fi.svg
Paddles
Excellent contact with the body is
essential
Gel required
Serious burns can occur if proper contact is
not maintained during discharge

Sufficient insulation is required

Prevents discharge into the physician
Paddles Types

Internal: direct cardiac stimulation

External: transthoracic stimulation

Adult
Pediatric

Disposable: used externally

Paddles Types

Disposable

Internal

External

Yury Masloboev (2007), Defibrillator, [photograph]. Retrieved from https://commons.wikimedia.org/wiki/File:Defibrillator_(UOMZ).jpg

Paddles Position

DHTLab (2015), Defibrilator Packet, retrieved from BMET Library

Paddles Position

Owain Davies (2012), Defib electrode placement, retrieved from https://commons.wikimedia.org/wiki/File:Defib_electrode_placement.png

 Schematics

Openstax College. Cardiac Muscle and Electrical Activity. From the publication: Biology. Rice University: 2013.
Internal (Implantable) Defibrillator

BruceBlaus (2013), Implantable Cardioverter Defibrilator [diagram]. Retrieved from

https://commons.wikimedia.org/wiki/File:Blausen_0543_ImplantableCardioverterDefibrillator_InsideLeads.png
Commercial Examples
External Defibrillator

Openstax College. Cardiac Muscle and Electrical Activity. From the publication:
Biology. Rice University: 2013.
Commercial Examples
Internal Defibrillator

Steven Rodriquez (2007), Defibrillator [photograph], retrieved from

https://www.flickr.com/photos/n28ive1/431939091

Gregory Marcus (2008) Implantable cardioverter defibrillator chest X-ray

[photograph] retrieved from
https://commons.wikimedia.org/wiki/File:Implantable_cardioverter_defibril
lator_chest_X-ray.jpg
Commercial Examples
AED

Wikipedia. Automated External Defibrillator.

Wikipedia, p. 1-5. Retrieved from:
https://en.wikipedia.org/wiki/Automated_external_def
ibrillator
 Safety

Avoid conducting mattress (spring),

bedstead or metal table
Wear surgeons rubber gloves with high-
voltage insulation
CAUTION: high current and voltage
associated with the circuitry.
Use GEL

Werneuchen (2008) Surgical Gloves [photograph].

Retrieved from
https://commons.wikimedia.org/wiki/File:Surgical_glov
es_26.JPG
 Preventive Maintenance

Replaced battery every 24 months

Defibrillators offer a selftest option which

should be done at least once a month
 Common Problems

Old Batteries

Paddles and cables contact

The gel build up on the paddles and have to be

cleaned with alcohol
 Test Procedures

Paddles should be inspected for pit marks

They could leave burns on the chest

 Test Procedures

Defribillator Selftest

Use a fresh meat (normally pig)

NEVER TEST THE PADDLES

AGAINST EACH OTHER!
Questions

?
Troubleshooting