Defibrillation

Jean O’Connor BSN, RN

Defibrillation
 What is Defibrillation?
 Defibrillation is a non-synchronized delivery of a shock
randomly during the cardiac cycle (Knight, 2019)

 This shock is a prespecified amount of energy in joules.

 Defibrillators delivery energy in a monophasic or biphasic

waveform.

 Monophasic defibrillators use an energy level of up to 360

joules.

 Biphasic defibrillators use lower energy levels around 120-

200 joules, and are more effective than monophasic
defibrillators (Knight, 2019).

 Defibrillation is used to treat Ventricular Tachycardia (VT),

and Ventricular Fibrillation (VF).
Defibrillation Waveforms
 What is Cardioversion?
 Cardioversion is the delivery of energy that is
synchronized to the QRS complex.
 Cardioversion terminates arrhythmias by delivering
a synchronized shock that depolarizes the tissue
involved in a reentrant circuit.
 Cardioversion terminates those arrhythmias resulting
from a single reentrant circuit such as atrial flutter,
atrioventricular nodal reentrant tachycardia,
atrioventricular reentrant tachycardia, or
monomorphic ventricular tachycardia.
 Cardioversion with a biphasic defibrillator uses
varying, but lower energy levels for the treatment of
atrial fibrillation (120-200 joules), for atrial flutter (50-
100 joules, and for ventricular tachycardia with a
pulse (100 joules).
Synchronized Cardioversion

Synchronized cardioversion delivers a shock synchronous

to the QRS complex. The defibrillator settings MUST
be set to synchronized (SYNC).
Copyrights apply
What is a Joule
 A joule is system international (SI) unit of work or energy
equal to the work done by a force of one newton acting
through a distance of one meter (Merriam-Webster, 2019)

 A joule is an extremely small amount of energy

 The SI unit of power is the watt. The watt is equal to one

joule of energy per second.

 So if we wanted to know how many joules of energy a 100

watt lightbulb used every hour, we would calculate: A
joule is 1 Watt second. 100 Watts times 3600 seconds is
360,000 joules (unitconverters.net, 2019).

 In a monophasic defibrillator the maximum amount of

joules used to defibrillate a patient is 360 joules.
 What rhythms require
defibrillation vs. cardioversion?
Ventricular Fibrillation Ventricular Tachycardia
(Requires Defibrillation) (Requires Defibrillation if pulseless,
Can be cardioverted if pulse is present.

Asystole
Supraventricular Tachycardia
(Does NOT Require Defibrillation.
(Requires Cardioversion:
Requires CPR/ACLS
Underlying rhythm: ?A-fib/A-
flutter
 Types of Defibrillators

1. Monophasic Defibrillator 2. Biphasic Defibrillator

3. Automatic External
Defibrillator (AED) 4. Implantable Cardioverter
Defibrillator (ICD)
 Fact vs. Fiction
 In-hospital cardiac arrest survival is about 23%
(Wesley & Wesley, 2016).
 Out-of-hospital cardiac arrest survival is
approximately 9% (Wesley & Wesley, 2016).
 In a study examining 35 scenes portraying
defibrillation in 32 different movies defibrillation
was performed in 29 scenes(83%). Seven (39%) of
the cardiac rhythm’s defibrillated were asystole
(Wesley & Wesley, 2016).
 Of 8 movie scenes with in-hospital cardiac arrest
7 (88%) resulted in survival (Wesley & Wesley,
2016)
 How might these statistics affect public
perception of cardiac arrest survival?
 Are these inaccurate scenes missed opportunities
for public health education (Mgbako et al., 2014)
 References
 AED.com. (2015). TV myth: shocking a flatline heart rhythm will revive patient. Retrieved

fromhttp://www.aed.com/blog/tv-myth-shocking-a-flatline-heart-rhythm-will-revive-patient/

 [Chris Sherry]. (2013, November 28). Homer heart attack. [Video file]. Retrieved from

https://youtu.be/FXjtwaGG3bw

 [DefibHer666]. (2011, June 23). Unknown movie-defibs on woman. [Video file]. Retrieved from

https://youtu.be/9H7SrIB_Gdk

 Knight, B.P. (2019). Basic principles and technique of external cardioversion and defibrillation.

Retrieved from UptoDate

 [krismarks]. (2008, September 28). Fringe S01E02 “same old story” – defibrillator

scene. [Video file]. Retrieved from https://youtu.be/csEZCurrO8c

 Merriam-Webster. (2019) joule. Retrieved from https://www.merriam-webster.com/dictionary/joule

 [Mostly Simpsons]. (2016, July 24). The Simpsons – this is the part of the job I hate. [Video file].

Retrieved from https://youtu.be/xK37Dbxr1OA

 References
 [MystifiedMystery]. (2014, November 28). [Video file]. Spiderman 3 defib scene. Retrieved from

https://youtu.be/goLSt7RnlhY

 [MystifiedMystery]. (2012, September 29). Casino royale defib scene. [Video file]. Retrieved from

https://youtu.be/9j9b31PQXKk

 [PennyKeating10]. (2009, March 6). Flatliners trailer. [Video file]. Retrieved from

https://youtu.be/oCm_NMU6Phw

 PHILIPS Heartstart. (2003). SMART biphasic a proven, fixed, low-energy defibrillation waveform.

Retrieved from

https://pdfs.semanticscholar.org/c271/01825699032ee4fcd320d84272911583c6f6.pdf

 Practical Clinical Skills. (2019). EKG lessons, practice strips and drills. Retrieved from

https://www.practicalclinicalskills.com/ekg

 [Scrantonicity “The Office Memes and More]. (n.d.). The Office-deleted scenes “Michael buys a

defibrillator.” [Video file]. Retrieved from

 References
 [supergray2001]. (2010, March 9). Scrubs: JD’s first code. [Video file]. Retrieved from

https://youtu.be/8icuwTjNoQk

 [Tom Bouthillet] (2007, December 26 ). E.T. gets defibrillated. [Video file]. Retrieved from

https://youtu.be/gEl-59jHqHA

 [tozekk]. (2010, August 20). The A team-Murdock. [Video file]. Retrieved from

https://youtu.be/b_0TKlOISCc

 UnitConverters.net. (2019). Convert joule to watt-hour. Retrieved from

https://www.unitconverters.net/energy/joule-to-watt-hour.htm

 Wesley, K., & Wesley, K. (2016). Study debunks defibrillation myths in movies. Journal of emergency

medical services. Retrieved from https://www.jems.com/articles/print/volume-41/issue-

40/departments-columns/street-science/study-debunks-defibrillation-myths-in-movies.html

 [Where’s The Jump?]. (2015, August 25). The thing (1982) jump scare-the defibrillation scene. [Video

file]. Retrieved from https://youtu.be/kozThyFY2p8