[tinderbox]

Can someone please tell me the differences between
defib, transcutaneous pacing (ie., in a code situation), and cardioversion. I'm referring to all during a code situation.

Thanks!

[curlysin]

hi there

ok let me see if i can help.

defib (defibrillation) means to defibrillate some one who is in a shockable rythm in the hope that you will convert them back to some kind of normal rythm or normal electrical activity. the 2 shockable rythms in an arrest situation is VT/VF.

Pacing can be used when a patient may have had a complete or intermittant heart block but there is atrial activity being thrown off from them to pace. or effectively cling onto to pace. or it can also be attempted in patients with a PEA < 40. ive only seen this happen in very young patients who they will try anything on to save them.

cardio conversion is used for patients in AF. caution is taken here as we all know AF causes pools of blood to collect in the chambers of the heart due to abnormal functioning of the pumping mechanisms. therefore an echo must be carried out immediately prior to a DC conversion. if this does not happen and you convert a patient you will cause them to have a massive CVA. in an arrest situation cardiovert will only be used if a patient is haemodynamicaly unstable ie hypotensive, sob, hypoxic etc.

hope this has helped ive tried to explain it in simpler terms for you.

[curlysin]

i forgot to mention if you pace someone externally you must keep them pacing until an internal pacemeaker can be fitted.

[vamedic4]

Originally Posted by tinderbox

Can someone please tell me the differences between
defib, transcutaneous pacing (ie., in a code situation), and cardioversion. I'm referring to all during a code situation.

Thanks!

Hi tinderbox...

defibrillation is a strong, immediately delivered current of energy delivered to the chest during a "code" situation (pulseless VT/VF) in order to restore "normal" electrical activity -AND A PULSE.

Transcutaneous pacing is used in cases where the patient's HR is too low to maintain perfusion..this is to include patients in higher level blocks...second degree type I/II and third degree blocks.

Cardioversion is used in patients WITH A PULSE. The difference between defibrillation and cardioversion is the delivery of the energy. In cardioversion, you are delivering the energy to a SPECIFIC AREA of the hearts depolarization/ repolarization cycle, a specific "part" of the rhythm you see on the EKG screen. They're in a rhythm that is at least PARTIALLY perfusing..whatever it may be...atrial fib, a-flutter, VT with a pulse, et cetera. By delivering the energy in this way, it is a more "controlled" way of getting a person back to a more perfusing rhythm, NSR, sinus tach. Defibrillating these people will more than likely bring about the kind of rhythm you don't want, like VF and VT...without a pulse. Then you'll be earning your money, I guarantee it.

vamedic4
Hot in Texas

I'm sure others will post great reference websites. Do a search to find some and you'll come across dozens, I'm sure!!

[curlysin]

vamedic4 youve put me to shame with your very well worded post. mine just sounds dense now!!!!!!!

[pghfoxfan]

Great explainations above. Just a couple more.

Defibrillation is unsychonized Vs Cardioversion which is synchronized
Cardioversion is usually planned which means, get a consent signed, premedicate (start IV and O2)
Paddle placement is important in Cardioversion. Energy delivered usually follows normal electrical pathway, vs defibrillation just zaps
Defibrillation can be done by just pressing the buttons, Cardioversion is looking for a certain part of the cardiac cycle therefore you must put on the synch button to "flag" the rhythm. (this needs turned back on each time you cardiovert) When it is time to cardiovert, the buttons have to be held down till the energy is delivered. Often the rhythms that need cardioverted are able to be stopped using a less amount of energy or (Joules). Such as 50 or 100 joules.

One more thing that pacing can do besides pacing a slow rhythm is attempting to pace someone out of a rapid rhythm, called anti tachy pacing. If someone is in a heart rate at 150, you can pace them at a rate slightly higher, capture their own heart rate, then stop pacing. Often, when you stop pacing at the higher rate, their own heart beat goes back to normal.

[tinderbox]

How do you remember all this??? I have only been a tele nurse since May. Sometimes I feel so incredibly overwhelmed, still, with all the information and the knowledge that these people could drop dead any minute!

[augigi]

Do it once and you'll remember. Just remember that anyone of us can drop dead at any time - at least these ones are being monitored!