Defibrillation

Definition

Defibrillation is the delivery of an unsynchronized high-energy electrical shock to the heart to terminate ventricular fibrillation (V-fib) or pulseless ventricular tachycardia (V-tach). Early defibrillation is the single most effective treatment for these rhythms.

Indications

• Ventricular fibrillation
• Pulseless ventricular tachycardia

Defibrillation vs Cardioversion

Defibrillation is unsynchronized, used for chaotic/pulseless rhythms. Cardioversion is synchronized to the R wave, used for stable but abnormal rhythms with a pulse (A-fib, SVT, stable V-tach).

Procedure

Apply pads or paddles (sternum + left chest or anterior-posterior). Set energy per manufacturer (typically 200 J biphasic). Ensure no one is touching the patient. 'All clear!' Deliver shock, resume CPR immediately for 2 minutes, such as do not defibrillate over pacemaker, medication patches, or wet skin.

Nursing Considerations

In witnessed arrest, defibrillate as soon as possible. Resume chest compressions immediately after shock without pulse check. Continue ACLS with epinephrine every 3 to 5 minutes and consider amiodarone for refractory V-fib/V-tach.

NCLEX Relevance

Priority for pulseless V-fib/V-tach, never defibrillate asystole or PEA.