DEFIBRILLATION

Indications: VF or pulseless VT.

Energy Levels: 
Adult monophasic energy levels first shock 200 J, second shock 200–300 J, third shock 360 J; continue at 360 J for further shocks. 

Biphasic energy level shocks use lower energy levels, approximately 150 J.

Procedure: 
Use handheld paddles or remote adhesive pads.
Always use a conducting gel with paddles and apply firm pressure to chest to ensure good skin contact. 
Dry skin if wet, shave excessive hair.

Methods: 
Manual or automated.

Precautions: 
Place paddles and pads several inches away from an implanted pacemaker.
May be used on children aged 1–8 years. But always use pediatric paddles or pads and follow pediatric protocols.

MANUAL DEFIBRILLATION

A manual defibrillator is used to restore a normal heart rhythm.
For a patient experiencing sudden cardiac arrest, first use the ECG tracing to verify that the rhythm is either VF or pulseless VT, and then manually deliver an electric shock to the heart.

Procedure
1. Verify patient is in cardiac arrest, with no pulse or respiration. Have someone provide CPR, if possible, while the defibrillator is obtained and placed next to the patient.
2. Turn on defibrillator; verify all cables are connected.
3. Turn “lead select” to “paddles” or “defibrillator.”
4. Select initial energy level for an adult to 200 J.
5. Paddles: Use conducting gel and place on apex (lower left chest, midaxillary) and sternum (right of sternum, midclavicular). Pads: Place in same locations as you would put paddles.

6. Verify rhythm as VF or pulseless VT.
7. Say, “Charging defibrillator, stand clear!”
8. Charge defibrillator.
9. Say, “I’m going to shock on three. One, I’m clear; two, you’re clear; three, everybody’s clear.” Perform visual sweep to assure all rescue personnel are clear of patient, bed, and equipment.
10. Discharge defibrillator, reassess rhythm, and refer to appropriate treatment algorithm for resulting rhythm.


AUTOMATIC EXTERNAL DEFIBRILLATOR (AED)

An AED is a small, lightweight device used by both professionals and laypersons to assess heart rhythm by computer analysis. If necessary, it administers an electric shock to restore a normal rhythm in patients with sudden cardiac arrest. A shock is administered only if the rhythm detected is VF or VT.
Procedure
1. Verify patient is in cardiac arrest, with no pulse or respiration. Have someone provide CPR, if possible, while the AED is obtained and placed next to the patient.
2. Turn on AED. Follow voice prompts or visual messages.
3. Open adhesive pads and attach pads to cables.
4. Attach pads to right sternal border and apex or as pictured on each of the AED electrodes
5. Clear patient and stop CPR.
6. Press analyze button, if present.
7. If shock is advised, say, “I’m going to shock on three. One, I’m clear; two, you’re clear; three, everybody’s clear.” Perform visual sweep to ensure rescue personnel are not touching patient or equipment. Press shock button. Reanalyze after shock and continue as prompted by the AED.
8. If no shock is advised, check for a pulse. If no pulse, start CPR.


Fully automatic AED analyzes the rhythm and delivers shock if indicated.
Semiautomatic AED analyzes the rhythm and tells operator that shock is indicated. If it is indicated, operator initiates shock.