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A defibrillator is a medical device used in the defibrillation of the heart. It consists of a central unit and a set of two electrodes. The central unit provides a source of power and control. The two electrodes are placed directly on or in the patient. The device is designed to deliver an electric shock to the patient, in an effort to stop ventricular fibrillation or ventricular tachycardia. Ventricular fibrillation is a situation of electrical chaos in the heart's conduction system, in essence distorting the coordinated contraction of cardiac muscular tissue. This leads to a situation where the heart produces minimal or no forward blood flow, causing circulatory arrest and death within minutes from hypoxic brain damage. The defibrillation current depolarizes the entire electrical system of the heart causing a complete ceasure of electrical activity. This, in turn, gives the opportunity of impulses from the normal conduction pathways to regain control of the muscular tissue of the heart.
Internal Defibrillators The device may be implanted directly in the user of the device. If so, it is known as an implantable cardioverter-defibrillator or (much less frequently) an internal cardiac defibrillator (ICD). This type of defibrillator is designed to provide immediate defibrillation to high-risk patients. By actively monitoring the pulse rate, rhythm, and waveform, and by comparing atrial and ventricular activity, an ICD can detect ventricular fibrillation, and immediately initiate defibrillation. External Defibrillators Biphasic Defibrillation Until recently, external defibrillators relied on shock waves. Electrical pulses are sent rapidly from one electrode to the other, only in one direction. Biphasic defibrillation, however, alternates the direction of the pulses, completing one cycle in approximately 10 milliseconds. Biphasic defibrillation was originally developed and used for implantable cardioverter-defibrillators. When applied to external defibrillators, biphasic defibrillation significantly decreases the energy level necessary for successful defibrillation. This, in turn, decreases risk of burns and myocardial damage. However, there is limited evidence to suggest that biphasic defibrillation is superior to monophasic defibrillators, although the small capacitor size required for the defibrillator can result in significant cost and size savings-- essential for the proliferation of Automated External Defibrillators. Automated External Defibrillators
Electrodes The electrode is a key part of any defibrillation system. The proper selection and placement of electrodes can determine the effectiveness of the procedure. Design
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. Inventor The first case of a human life saved by defibrillation was reported by Beck et al in 1947. Claude Beck successfully revived a patient in an operating room using an open-chest electric defibrillation device. The first man to discover that DC electricity is most effective for treating arrhythmias like ventricular fibrillation and ventricular tachycardia is Bernard Lown. AC electricity cannot be used because it is considerably more likely to induce ventricular fibrillation rather than terminating it. The closed-chest defibrillator device was pioneered by Dr V. Eskin with assistance by A. Klimov in the city of Frunze, USSR in mid 1950s. Successors of this device continue to be used to this day. Another advance was the development of a mobile defibrillator in 1966. The device was suitable for installation in ambulance vehicles and was developed by cardiologist Frank Pantridge in Belfast, Northern Ireland. This is one of the innovations that led to modern EMS and, in the late 1990s, the mobilization of advanced cardiac life support with paramedics. Defibrillators in popular culture The defibrillator was first seen on film in the 1966 movie Fantastic Voyage. Since then they have appeared in many modern television and film medical programs. Its use in the near-death experience experiments by the characters of the 1990 movie Flatliners made the defibrillator virtually one of the co-stars of that film. It was also utilized in plotlines in several films and TV series. In many movies, the person using the defibrillator yells "Clear" right before he or she applies the shock, to warn everyone around to stay away from the patient for risk of electrical shock. In most telemedia programs, the defibrillator induces a sudden, violent jerk or convulsion by the patient; in reality, although the muscles may contract, such dramatic patient presentation is rare. Most television shows will have the medical provider defibrillate the "flat-line" ECG rhythm (also known as asystole); this is not done in real life. Only the cardiac arrest rhythms ventricular fibrillation and ventricular tachycardia are normally defibrillated. (There are also several heart rhythms that can be "defibrillated" when the patient is not in cardiac arrest, such as supraventricular tachycardia or ventricular tachycardia that produces a pulse, though the procedure is then known as cardioversion.) However, a flatline may actually be a fibrillation that is too weak to be seen on the monitor (fine v-fib), so a shock may be delivered, but it is not regarded as the treatment of choice, as the probability of a successful conversion is very small. According to the current guidelines, in this situation, continued CPR in order to improve the oxygenation of the heart for a few minutes is preferred before defibrillation is attempted. See also | ||||||||||||
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