Lec4 2019
Lec4 2019
Systems
EQUP5335
Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATORs & Cardioverters
2 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATORS & CARDIOVERTERS
Defibrillator is a device that sends electrical energy, or shock, to the heart.
The need for this generally arises when the patient has ventricular
fibrillation or ventricular tachycardia, which are life-threatening arrhythmias
that occur when contraction of the ventricles become abnormal.
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DEFIBRILLATORS & CARDIOVERTERS
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TYPES OF DEFIBRILLATORS
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HEART ABNORMITIES
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CARDIOVERSION
Synchronized defibrillation is referred to as cardioversion
Pulse of energy is triggered by R wave in the ECG
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TYPES OF DEFIBRILLATORS
There are different kinds of defibrillators in use today. They include the
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TYPES OF DEFIBRILLATORS
•Manual internal defibrillator:
- The manual internal defibrillators use internal paddles to send the electric
shock directly to the heart. They are used on open chests, so they are only
common in the operating room. It was invented after 1959
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TYPES OF DEFIBRILLATORS
14 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
TYPES OF DEFIBRILLATORS
Automated external defibrillator (AED):
These are defibrillators that use computer technology, thereby making it easy
to analyze the heart’s rhythm and effectively determine if the rhythm is
shockable.
They can be found in medical facilities, government offices, airports, hotels,
sports stadiums, and schools.
15 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
TYPES OF DEFIBRILLATORS
•Implantable cardioverter-defibrillator:
- Another name for this is automatic internal cardiac
defibrillator (AICD).
- They constantly monitor the patient’s heart, similar to a
pacemaker,
- can detect ventricular fibrillation, ventricular
tachycardia, supraventricular tachycardia, and atrial
fibrillation.
- When an abnormal rhythm is detected, the device
automatically determines the voltage of the shock to
restore cardiac function.
- provide Pulses from 5-30 J
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TYPES OF DEFIBRILLATORS
•Wearable cardiac defibrillator:
Further research was done on the AICD to bring forth the wearable cardiac
defibrillator,
- which is a portable external defibrillator generally indicated for patients
who are not in an immediate need for an AICD.
- This device is capable of monitoring the patient 24-hours-a-day.
- It is only functional when it is worn and sends a shock to the heart
whenever it is needed.
However, it is scarce in the market today.
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
BASIC DEFIBRILLATOR TYPES(Waveforms)
AC defibrillator
capacitive-Discharge DC Defibrillators
-
1- lown
2- monopulse
3- tapered (dc) delay
4- trapezoidal wave.
square-wavedefibrillator
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
AC DEFIBRILLATOR
• Before 1960 were AC model
• This First defibrillators machine used several
hundred volts applied 5 to 6 A of 60 Hz across
the patient’s chest for 250 to 1000 ms.
• The success rate for AC defibrillator was rather
low
• Since 1960, several different dc defibrillators
have been devised.
• This machines store a dc charge that can be
delivered to the patient.
• The different between dc types in the wave shape
of the charge delivered to the patient
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
ADVANTAGES OF DC VS. AC
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
LOWN
- The current will rise very rapidly to about 20 A under the influence of slightly less than
- 3 kV .
- The waveform then decays back to zero within 5 ms and then produces a smaller
negative pulse also about 5 ms.
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
LOWN WAVE FORM DEFIBRILLATOR
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CLASSES OF DISCHARGE WAVEFORM
- Tapered delay wave form , a lower amplitude 1.2 kV and longer duration 15 ms
to a chive the energy level
- It is created by placing two L–C sections
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CLASSES OF DISCHARGE WAVEFORM
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CLASSES OF DISCHARGE WAVEFORM
There are two general classes of waveforms:
a)mono-phasic waveform
• Energy delivered in one direction through the patient’s heart
b)Biphasic waveform
• Energy delivered in both direction through the patient’s heart
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CLASSES OF DISCHARGE WAVEFORM
Biphasic waveforms are preferably used
More effective on first shock and gentler on heart with less dysfunction
Differ with varied adaptation to thoracic impedance of patient (e.g., peak-to-peak voltage
and pulse duration)
Defibrillation success achieved with lower energy and voltage
Device-dependent amount of energy is 150–200 J for first defibrillation and 200–360 J for
all others, whereas it is always 360 J with monophasic wave
Biphasic pulse forms allow devices to be further miniaturized
Synchronous: heart’s own pulses are taken into account (QRS triggering)
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CLASSES OF DISCHARGE WAVEFORM
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CLASSES OF DISCHARGE WAVEFORM
• Differences between monophasic and biphasic systems
In monophasic systems, the current travels only in one direction - from one
paddle to the other.
• In biphasic systems, the current travels towards the positive paddle and
then reverses and goes back; this occurs several times .
• Biphasic shocks deliver one cycle every 10 milliseconds and they are
associated with fewer burns and less myocardial damage.
• With monophasic shocks, the rate of first shock success in cardiac arrests
due to a shockable rhythm is only 60%, whereas with biphasic shocks, this
increases to 90%.
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
THE SQUARE AND TRAPEZOIDAL WAVEFORM DEFIBRILLATO
Figure 13.10 The square and trapezoidal waveform defibrillator may have a battery that drives the ac
charging supply. Diode D rectifies the ac to charge capacitor C. Series SCR1 is turned on to deliver
current to subject RL. The timing circuit calculates the charge delivered, then after duration d, shunt
SCR2 short circuits the charge. (From L. A. Geddes, Cardiovascular Devices and their Applications, New
York: John Wiley & Sons, 1984.)
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CARDIOVERTER
Special defibrillator constructed to have synchronizing circuitry so that the
output occurs immediately following an R wave
In patients with atrial arrhythmia, this prevents possible discharge during a
T wave, which could cause ventricular fibrillation
The design is a combination of a cardiac monitor and a defibrillator
Cardioscope
ECG Analog
ECG AMP
Electrodes Switch
Defibrillation Operator-controlled
Electrodes Defibrillator Switch
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR TYPES
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR TYPES
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
THORACIC IMPEDANCE
Definition: resistance in body which opposes energy pulse from defibrillator
RT
WT WA
RD 2 RE RT
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
LOWN WAVE FORM DEFIBRILLATOR
EXAMPLE
A defibrillator has an available energy, WA, of
200 joules (J).
If the thorax resistance is 40 ohms (W), the
electrode—skin resistance of a paddle with
sufficient electrode gel is 30 ohms and the
internal resistance of the defibrillator is 10
ohms.
Calculate the energy delivered to the
thorax of the patient.
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
LOWN WAVE FORM DEFIBRILLATOR
.
EXAMPLE
A defibrillator provides a 5 ms pulse of 20 A
to a 50 load.
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR ELECTRODES
Types of Defibrillator electrodes:-
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR ELECTRODES
Types of Defibrillator electrodes:-
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR ELECTRODES
Electrodes
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
PADDLES VERSUS ADHESIVE PATCHES
Paddles were originally used but their use is being superseded by adhesive
patches.
Adhesive patches are placed most commonly antero-apically - the anterior
patch goes under the right
clavicle and the apical patch is placed at the apex.
Adhesive electrodes are better, as they stick to the chest wall, so there is no
mess with gels.
Paddles require a significant level of force, which is not needed with adhesive
electrodes.
• Adhesive electrodes also allow good ECG trace without interference.
They are also safer, as no operator is required - although, before discharging a
shock, it is important to ensure everyone is clear of the patient
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
Thank You
Any question ?!
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