Which Of The Following Should Not Be Done During Defibrillation

Which Actions Should Be Avoided During Defibrillation? A Comprehensive Guide

Defibrillation is a life-saving procedure used to treat life-threatening cardiac arrhythmias like ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). It involves delivering a controlled electrical shock to the heart to reset its rhythm and restore a normal heartbeat. While a crucial intervention, defibrillation requires meticulous adherence to safety protocols to ensure patient safety and maximize the chances of success. This comprehensive guide details the actions that should absolutely be avoided during defibrillation to prevent complications and improve outcomes.

Before Shocking: Crucial Precautions to Take

Before even touching the defibrillator, several critical steps must be taken to prepare for the shock delivery and ensure patient and operator safety. Failing to adhere to these precautions increases the risk of adverse events, including accidental shocks and ineffective defibrillation.

1. Never Touch the Patient During Shock Delivery

This is paramount. Any contact with the patient while the shock is delivered can result in the operator receiving the electrical shock, causing severe injury or even death. All personnel must be clear of the patient and equipment before delivering the shock. Ensure everyone is at a safe distance and not touching the patient or the bed. A clear announcement, such as "Clear!" should be made before delivering the shock. This ensures everyone understands the impending shock.

2. Never Use a Defibrillator on a Patient with a Pacemaker or Implantable Cardioverter-Defibrillator (ICD) Without Specific Training

While defibrillation is generally safe, the presence of a pacemaker or ICD requires specialized knowledge and techniques. The shock could potentially damage the implanted device. Always check the patient's medical history for the presence of such devices before attempting defibrillation. If present, seek guidance from experienced medical professionals who are familiar with defibrillating patients with implanted devices. Improper technique can lead to malfunctioning devices or ineffective defibrillation.

3. Never Attempt Defibrillation Without Proper Training and Certification

Defibrillation is a complex procedure that requires extensive training and certification. Improper technique can lead to ineffective defibrillation, patient injury, and even death. Only trained and certified personnel should perform defibrillation. This ensures the procedure is performed correctly, minimizing risks and maximizing the chances of a successful outcome. Improper handling of the paddles or electrode pads, misinterpreting the heart rhythm, and improper shock delivery can all have severe consequences.

4. Never Delay Defibrillation if Necessary

Time is critical during cardiac arrest. Every second counts. Delaying defibrillation significantly reduces the chances of successful resuscitation. If the patient is in VF or pulseless VT and meets the criteria for defibrillation, initiate the procedure immediately. Time spent on unnecessary steps or hesitation can dramatically lower the probability of survival. Proper assessment and immediate action are essential.

5. Never Fail to Check the Patient's ECG and Confirm Rhythm

Before administering a shock, it is essential to verify the patient's cardiac rhythm using an electrocardiogram (ECG). Only defibrillate patients experiencing ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). Defibrillating a patient with other rhythms can be dangerous and ineffective. Confirm the rhythm accurately before proceeding. Misinterpretation of the ECG can lead to inappropriate shocks and potentially harm the patient.

During Shock Delivery: Essential Safety Measures

The actual moment of shock delivery demands strict adherence to safety protocols. Any deviation from these procedures can have life-threatening consequences.

6. Never Fail to Ensure Proper Electrode Placement

Correct placement of the defibrillator pads (or paddles) is crucial for effective and safe defibrillation. Improper placement can lead to ineffective shocks, burns, or even internal injuries. Follow the manufacturer's instructions and ensure the pads are firmly placed on the patient's chest in the designated areas. Use appropriate-sized pads for the patient’s size. Incorrect placement can lead to an inadequate shock and a potential failure to restore normal heart rhythm.

7. Never Apply Excessive Pressure During Shock Delivery

While the pads need to be firmly applied, excessive pressure can cause burns to the patient's skin. Apply firm, even pressure without forcing the pads onto the chest. Ensure good contact between the pads and the skin to reduce resistance and ensure efficient shock delivery. Excessive pressure can also impair electrical current flow, diminishing the effectiveness of the shock.

8. Never Neglect to Check the Defibrillator Settings

Before delivering the shock, always double-check that the defibrillator is set to the correct energy level (typically 120-200 joules for initial shocks in adult patients). Incorrect settings can lead to an ineffective shock or unnecessary harm. Verify the energy setting carefully before charging and discharging the device. Reviewing the machine settings thoroughly prior to shocking is a critical preventative measure.

9. Never Attempt Defibrillation Without Ensuring Adequate Gel or Paste

The use of defibrillation gel or conductive paste is crucial to reduce skin impedance and ensure efficient shock delivery. Applying the gel ensures proper conductivity and prevents burns. Ensure adequate contact between the pads and the patient's skin. Insufficient gel or paste can lead to resistance and ineffective defibrillation.

10. Never Touch the Patient or Equipment During Charge and Discharge

Once the defibrillator has been charged, all personnel must maintain a safe distance and avoid touching the patient or any part of the equipment. Touching the equipment during the discharge process can cause serious injury. Clearance must be ensured prior to shock delivery. This crucial step prevents electrical current from harming anyone involved in the procedure.

After Defibrillation: Post-Shock Procedures

Post-shock procedures are as important as the defibrillation process itself. Neglecting these steps can compromise patient survival.

11. Never Neglect Immediate Post-Shock Assessment and CPR Resumption

Immediately after the shock, assess the patient's rhythm and pulse. If the patient remains in cardiac arrest, resume CPR immediately. Chest compressions should be started without delay. Continuous monitoring and prompt action are vital for optimal survival chances. Failure to resume CPR following unsuccessful defibrillation can prove fatal.

12. Never Discontinue CPR Too Soon

Even after a successful defibrillation, the patient may still require CPR and further support to stabilize their condition. Continue providing CPR until the patient shows signs of spontaneous circulation. Discontinuing CPR prematurely can result in the patient relapsing into cardiac arrest.

13. Never Assume One Shock is Sufficient

Often, multiple defibrillation shocks are necessary to restore a normal heart rhythm. Continue defibrillation as necessary, following the recommended guidelines and protocols based on the observed rhythm. A single shock might not be enough to reverse the arrhythmia. Persistence and adherence to established protocols are crucial.

14. Never Fail to Document All Details of the Defibrillation Event

Maintain detailed records of the defibrillation event, including the time, energy level, number of shocks administered, and the patient's response. Accurate documentation is crucial for monitoring treatment effectiveness and evaluating future care. These details are vital for improving patient care practices and research.

15. Never Forget the Importance of Post-Resuscitation Care

Post-resuscitation care is vital for patients who have undergone defibrillation. This involves ongoing monitoring, oxygen therapy, medications, and supportive measures to ensure the patient's recovery. Neglecting post-resuscitation care can lead to complications and decreased chances of survival. This final phase is essential for achieving successful patient outcomes.

Conclusion

Defibrillation is a critical life-saving procedure, but its efficacy and safety depend entirely on strict adherence to established protocols. By avoiding the actions outlined in this comprehensive guide, medical professionals can significantly reduce the risks of complications, increase the chances of successful resuscitation, and ultimately, save lives. Remember, proper training, meticulous attention to detail, and a commitment to safety are paramount in the performance of this vital intervention. Thorough understanding of these guidelines is essential for any healthcare professional involved in emergency response and cardiac care.