What is a Defibrillator: Definition, Working Principle, Best Procedure24

What is a defibrillator?

A defibrillator is designed to treat ventricular fibrillation, sending a brief electric current through the heart causing the muscle to depolarize and allowing the body’s natural pacemaker to take control. This electrical current has the ability to break an abnormal heart rhythm such as ventricular tachycardia or ventricular fibrillation in the lower chambers of your heart and return it to a normal rhythm.

Using a difference in voltage, a pair of electrodes and an electrically conductive gel facilitate this current. By lowering the natural resistance of body tissues, the gel prevents electrical burns. Defibrillator electrodes used in the past were metal paddles with insulated handles. However, some modern defibrillators use adhesive pads that already contain conductive gel.

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How does a defibrillator work?

There are a few things to keep in mind before doing this, you should continue to give CPR as long as you wait to be ready to use the defibrillator. Before shocking the patient, ensure that no one is touching the person.

If you are using an automated external defibrillator (AED) in an emergency, it can review the heart rhythm to determine whether it needs a shock or how much. An AED charges itself and provides verbal instructions on how to use it.

To do this, your healthcare provider will do the following:
Place two defibrillator paddles or sticky pads on your chest. One paddle or pad goes under your right shoulder and the other under your left nipple. To prevent electrical burns in the process, the pad already has a conducting material or gel. However, your doctor will need to put operating material on your chest before using the pedals.

To jerk a button is pressed on the machine followed by a handheld pedal, press the button on each pedal at the same time.
A defibrillator stops your heart muscle from moving for a period of time so that the heart can generate an electrical impulse that starts a normal rhythm. In short, defibrillation restarts your heart.

What is a defibrillator used for?

Anyone with any of the above arrhythmias can get help where an automated external defibrillator is available. However, if you are at high risk of life-threatening heart arrhythmias, you may need your own defibrillator that is with you at all times.

Defibrillator for personal use

This personal defibrillator may jerk or be painless or it may feel like someone has kicked you in the chest.

For people who are at high risk for a life-threatening heart rhythm, these defibrillator types may:

Wearable cardioverter defibrillator: You can wear it under your clothes as a vest. The sensors in it make contact with your skin, and the device can send a shock after sensing an abnormal rhythm.

An implantable cardioverter defibrillator (ICD):- Acts like an internal monitor for arrhythmias, an implantable cardioverter defibrillator can send the right amount of charge when needed. While T is similar to a pacemaker in its ability to maintain a heartbeat, a defibrillator has the additional ability to shock the heart when a lethal rhythm is detected.

Why is a defibrillator used?

Cardiopulmonary resuscitation (CPR) provides temporary support, while a defibrillator helps you survive a sudden cardiac arrest. If someone already has a pacemaker or implantable cardioverter defibrillator (ICD), you can also use a defibrillator.

What happens during cardiac arrest?

Sudden cardiac arrest (SCA) is a condition in which the heart stops beating suddenly and unexpectedly due to ventricular fibrillation (VF), a problem with the heart’s electrical system.

When this happens, blood cannot flow to the brain and the rest of the body. When blood flow is cut off, the victim falls into a state of unconsciousness. And within no time he dies.

The mechanisms behind SCA vary, but they all stem from disturbances in the heart rhythm. A consistent rhythm of electrical activity directs the heart muscle to work in tandem. But due to disruptions in this behavior, irregular, very fast, or very slow heartbeats are called arrhythmias. The arrhythmia leads to ventricular fibrillation, where the heart muscles vibrate or flutter instead of contracting in a coordinated manner.

This is where SCA usually starts. And it can also manifest in an electrical rhythm that appears normal but fails to produce a pulse, which is called pulseless electrical activity or electromechanical dissociation. In more severe cases, the heart and electrical rhythm stop completely, which is called asystole or cardiac flatline.

Coronary artery disease, and other structural heart diseases, account for most cases of SCA. Sometimes these conditions are genetic. Even though they affect the electrical behavior in the heart muscle and continue to increase the risk of arrhythmias.

SCA can also result from injury, severe bleeding, poisoning, electric shock, or drowning in water. It is often observed that there are no warning signs or symptoms before SCA. But sometimes patients may experience chest pain, shortness of breath, dizziness, vomiting and blackouts.

During cardiac arrest, the patient lacks a regular pulse, leading to loss of breath and loss of consciousness. Heart attack is often considered synonymous with cardiac arrest. However, it has been observed that a heart attack (myocardial infarction) damages the heart muscle due to loss of blood flow to a part of the heart or a blockage of blood.

Using an AED

AEDs have automated functionality and are installed in many public places to even guide the user through the process, yet it is important to know that the victims are treated as soon as possible. How to use them effectively, especially since first responders can take an average of 7 to 12 minutes to get to the scene.

What is the procedure for using an AED?

Examine the patient to verify fainting and shortness of breath and regular pulse. Use an AED if there is a problem. First, remove the electrode pad from the plastic and place it on the patient’s bare skin. In this, one electrode is placed just below the right clavicle of the patient and the other is placed on their left hand side just below the pectoral muscle and on the left side.

This position allows an effective current for both the ECG reading and defibrillation. and temporarily stop CPR and allow the AED to analyze the patient’s heart rhythm. If the rhythm indicates that defibrillation may help, the machine will either instruct you to press the shock button or to withdraw from the electrodes as it automatically controls the shock.

When the AED indicates that it is safe to do so, continue with CPR until the patient shows signs of restored heart function or assistance arrives. Also the AED may instruct you to give additional shocks. If the AED indicates that the patient does not exhibit ventricular fibrillation, do not press the shock button. Continue CPR until emergency services arrive.

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What is the defibrillator working principle?

It is able to perform the vital function of the heart pumping blood that is lost through the synchronization of the heart muscle fibers. There is a method of bringing the fibers back to their normal synchronizing function called defibrillation. It involves delivering therapeutic doses of electrical energy to the affected heart with a device called a defibrillator. Defibrillators can be external, transvenous, or implanted, depending on the nature of the device used. On the basis of this, fibrillation is classified into atrial fibrillation of atrial muscles and ventricular fibrillation is called ventricular fibrillation.

Earlier mechanical methods such as heart massage were used to achieve synchrony of the heart muscle. But the most successful method of defibrillation proved to be an application of electric shock to the region of the heart. Fibrillation can be stopped if enough current is applied to stimulate all of the heart muscle for a short period of time. Early defibrillators used alternating current that changed from normal line voltage to 300 to 1000 volts from the power socket to the exposed heart via paddle type electrodes.

This application of an electric shock to re-synchronize the heart is called counter shock. However, if the patient does not respond, this method is repeated until defibrillation occurs. This method of defibrillation is called AC defibrillation. Nowadays this type of defibrillation is not used as it can have some disadvantages. This technique is often unsuccessful and damages post-mortem cells of the heart muscle. The nature of an AC machine with a large transformer also made these units very difficult to move and they became very large units. So DC defibrillators are now commonly used.

Troubleshooting of Defibrillator

1. First you inspect the defibrillator for external cracks, broken switches, knobs and indicators.

2. See BTA skill set on switches and lighting/indicators to identify and replace damaged switches and indicators.

3. Examine the cover, pad, and cable of the defibrillator properly for gel and dirt. To clean the defibrillator see the BTA skill set to Cleaning. If necessary, detect damage to the casing with the BTA skill on the casing
4. Power the device from the AC line and turn it on.
5. Check the power supply using a multimeter as well as inspect the wiring and connections from the circuit board to the other boards. See the BTA skill set on Connections to identify and fix broken wires and bad connections.

6. Check the fuse and if the fuse is defective, replace it as per the rating.
7. Most defibrillators can draw power from the battery and AC power mains.
8. Disconnect the defibrillator from the AC power line. Turn on the device.
• If the battery/status indicator is red, the battery needs to be charged or replaced (non-rechargeable).
• If the defibrillator does not turn on, the battery is completely exhausted or damaged

09. To replace and identify damaged batteries, replace the serial number and model specified on the batteries.
10. To troubleshoot the charging circuit, check the transformer and the regulator.
11. Power the device from the AC line and turn it on. The device will run an automatic self-test.
12. The result of the self-test will be displayed (on the screen) or the status indicator will turn red/green.

13. Its pedals should be clean and dry. Inspect pad cables and connectors for cut and broken wires.
14. The pedal electrode should have a metal paddle with an insulated handle.
15. These paddle electrodes are reusable and must be cleaned after each use. Connections and connectors must be replaced to identify and replace damaged cables.
16. Self-adhesive electrodes should be replaced after each use.

17. The defibrillator test can be performed on a commercial tester or on a large piece of meat.
18. Connect the first pad to the defibrillator analyzer, then select energy and press the charge button. Record delivered energy from the display of the once charged push discharge button defibrillator analyzer. Repeat the process for different energy levels.
19. Improper functioning of internal circuits if the defibrillator provides less or no energy than the limit set by the manufacturer.

20. Set the power in it to maximum and press the charge button. Once charged, place the pad on a large piece of meat then press the discharge button. Repeat this process 10 times. The piece of meat should be large enough to allow the defibrillator paddle to be placed more than 6 inches away.
21. Failure of the internal circuitry occurs if no burn marks are found on the piece of meat.
22. Have the equipment manufacturer checked for possible repair and replacement of internal circuitry components.
23. If the defibrillator is working properly, perform preventive maintenance before returning the equipment to clinical personnel.

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