Defibrillation
In ventricular fibrillation there is uncontrolled and uncoordinated depolarisation of the heart muscle. Defibrillation leads to simultaneous depolarization of most myocardial cells (Reset) and can thereby give the pacemaker centers of the heart the opportunity to regain control of the heart rhythm.
The therapy of ventricular fibrillation is therefore immediate defibrillation.
It is recommended to always apply defibrillations as a series of three. Starting with 200 joules, a second defibrillation with 200 joules is connected in the case of failure and a third with maximum energy (usually 360 joules) is connected (ERC) in the case of continuing ventricular fibrillation.
The decisive factor for the success of ventricular fibrillation therapy is not the set energy value in joules, but the current flow through the heart resulting from this therapy. In addition to the pre-selected energy, this is determined by the skin resistance, body mass and paddle position.
In order to achieve the highest possible current flow, defibrillation should preferably be performed with electrode gel, and the paddles should be pressed onto the patient under maximum pressure. As electrode positions, the points on the right parasternal under the clavicle or medioclavicular over the apex of the heart (corresponding to the derivation V4 and V5 in the ECG) are recommended (ERC + AHA). Alternatively, for example with defibrillator or pacemaker wearers (please note!) and with children and extremely small people, an anterior-posterior position of the paddles would be preferable (anterior = tip of the heart, posterior = two to three fingers under the scapula). An increase in the current flow through the heart is also achieved by the shortest possible pauses between the three defibrillations (recommendation: three shocks within thirty seconds). Keyword: Shot, loading, looking (ECG)!