notes by dr Claudio Italiano
All of you have certainly seen the American series ER, doctors in the
forefront, reporting episodes of action medicine, with doctors who resuscitate
patients in cardiac arrest for some time (sic!), Almost dead, as I say joking!
In reality, health is a complex system based on practice and practical science.
Today we are certainly at the forefront here in Italy, despite what is said, in
according to the few resources available. Suffice it to mention the fact that
the American health system is adapting to our SSN. Here we want to talk about a
dangerous arrhythmias, ventricular fibrillation (VF). and how it is appropriate
to intervene to rescue a patient in ventricular fibrillation. Even the
undersigned several times had to defibrillate a patient to restore him the
heart rhythm, but this maneuver happened successfully only sometimes,
often due to the critical condition of the patient.
In fact, despite having intervened in time, assisted by a resuscitator, it is not always possible to reanimate a patient, if the problem is due to a dangerous arrhythmia, ventricular fibrillation. For this reason there is a medical device, the defibrillator, a machine that performs a ECG, generally appreciated on monitors and has two knobs with which to obtain an electric shock on the heart and get the restoration of sinus rhythm.
Defibrillation is a treatment for life-threatening cardiac dysrhythmias, specifically ventricular fibrillation (VF) and non-perfusing ventricular tachycardia (VT). A defibrillator delivers a dose of electric current (often called a countershock) to the heart. Although not fully understood, this would depolarize a large amount of the heart muscle, ending the dysrhythmia. Subsequently, the body's natural pacemaker in the sinoatrial node of the heart is able to re-establish normal sinus rhythm.
Meanwhile, the word "fibrillare" means to tremble, but if it is referred to the heart it can mean that there is a severe arrhythmia, ie the sinusal rhythm, that is generated by our natural pacemaker or node of the sinus, has been replaced by a chaotic rhythm, characterized by irregular waves, such as ventricular fibrillation, while in reality the heart does not beat and it is paralyzed. The patient is into a condition called "cardiac shock".
The patient is down on the ground, usually does not breathe, with cyanotic lips, sweaty, sometimes with foam at the mouth and the strange eye, fixed, barred still, almost as if the soul has flown away from the body and the body in exitus, meaning the patient is dying if you do not do something right away.
Maintain the vital function of the patient, beats and breath, then start the rianimation!
Start resuscitation maneuvers immediately !
In the meantime it is necessary that other people request the assistance calling 118 (in Italy), 112 (in Europe) or 911 (USA), the national number of the emergency health, with the first phone, including your mobile device. This number is free and is possible to call from any mobile phone, even without credit.
The resuscitation maneuvers are characterized by
n. 2 insufflation of air in the mouth and n. 30 compressions on the breastbone
alternately, placing the
two hands flat, one above the other and pushing on the sternal handlebar as
shown in the figure, to compress the heart and obtain a sort of systolic
ejection.
In short we give 2 insufflations of air inside the patient's mouth and 30 pushes
on the heart, at the height of the breastbone
At this point, the patient begins to become less cyanotic, and seems to give
some signs of reaction ... If everything is OK, in general, if they do not want
it up there, go back with the soul and the body takes up again and reopens eyes.
But if there isn't no response, you must continue the same
resuscitation maneuvers for 30 minutes. Keep in mind that the chances of
saving a person in cardio-respiratory arrest, with the consequent damage to the
most important organ, ie the brain, fall by 10% every minute lost. It should
also be remembered that the fundamental maneuver for life is to maintain with
the massage and with the mouth-to-mouth, mouth-nose ventilation (in case of
problems in the mouth such as breaking of the jaw, serious obstructions, etc.)
or breathing by means of an Ambu's ball, or by a mask with a constant and
sufficiently flow of air and pushing on the heart to obtain a blood flow for the the brain. However, after 4 minutes of
absence of oxygen to the brain, brain damage occurs in many reversible cases,
from 6 minutes of hypoxia onwards the damages become irreversible.
Rescuers should arrive at last!
The ambulances are equipped with medical and defibrillator as well as various devices. For example, the general term "automatic external defibrillator" refers to external defibrillators that incorporate a rhythm analysis system. In fact, defibrillation aims to restore the rhythm, as I said before. Some devices are completely automatic, while others are semi-automatic and only the semi-automatic are marketed in Italy. All defibrillators are connected to the patient with two adhesive electrodes using connection cables. These adhesive electrodes have two functions: to record the rhythm and deliver the electric shock. A fully automatic defibrillator only requires the operator to connect the defibrillator electrodes and turn the device on. Then the apparatus analyzes the rhythm; if you are in the presence of V.F. (or TV with preset characteristics) the device loads its capacitors and delivers the shock. The semiautomatic devices, on the other hand, require a greater interaction with the operator, which in this case is almost always a doctor, who must activate the "analysis" command to start the rhythm test and then the "shock" command "if it is necessary to deliver the shock. Some defibrillators allow you to activate the charge and to choose the intensity and to download the two buttons on the knobs, which in the meantime are placed on the patient's chest as shown in the figure.
It is clear that I am not going to discharge the device if I am not sure that
the patient is completely in a ventricular fibrillation condition. An example is
the ECG on this page where a V.T. is appreciated vs a V.F.
There are still certain devices that are able to avoid inappropriate shocks,
analyzing, as we said, heart rate, the type of ecg and artifacts: if the patient
moves the path is altered, or there may be a tracing with atrial fibrillation,
for example alternating with ventricular tachycardia run.
Rescuers should not touch the patient while the device analyzes the rhythm, or
worse charges the capacitors and, obviously, while delivering the shock and
there must not be water in the ground, for example if it rains ! External chest
compressions and artificial respiration should not be performed while the device
is engaged in these functions. Otherwise the electric shock will hit the
operator!
All defibrillators can be used in four simple steps:
1. Turn on the device.
2. Connect it to the patient.
3. Start the rhythm analysis.
4. Dispense the discharge if necessary.
- the first rescuer who as a rule has the function of leader, arranges the
device next to the patient turns it on, discovers the chest and prepares it,
prepares the plates, connects them to the cable, then applies them on the chest
- the second rescuer at the same time performs the ABC., air, breath and
circulation, ie ascertained absence
of breath and carotid pulse! Ascertained the absence of consciousness and breath,
without carrying out the two ventilations foreseen by the mentioned heads
maneuvers. Then it is evaluated for 5-15 seconds what happened, that is if the
ventricular fibrillation has ceased. The administration of the shock usually
causes contractions of the patient's musculature, as is the case with a
conventional defibrillator. After the first discharge has been given, the pulse
is not checked, but the analysis button must be pressed immediately, starting
another cycle of heart rhythm evaluation. If the VT persists, the device will
make it known, and it will be repeated, for the second and third defibrillation,
the sequence loading-shock in rapid sequence. The energy levels of the second
and third shock, according to the guidelines are respectively 200 and 360 J. If
the third defibrillation was not successful, rescuers, evaluated the absence of
the carotid pulse, begin to practice resuscitation for a minute. After this
period, they proceed to check the carotid pulse. If absent, they activate the
device and try for the third time at 360 J, without stopping to evaluate the
pulse between one shock and another.
To learn more about arrhythmias:
>> >> >>
Arrhythmias
The dangerous atrial fibrillation,
Explanation of the electrocardiogram (ECG)
Criteria for reading an ecg
T waves of ischemia
Ecg and heart attack