DCC & Pacing - C Waters
Summary
This on-demand teaching session is tailored for medical professionals. It covers practical application of using defibrillators for Pearison and Bradicardia algorithms. The presentation will demonstrate how to set up a defibrillator and discuss the clinical parameters to be aware of and the environment in which it can be correctly administered. Participants will be given the resources for best and training practices for the system. By the end of the 20 minutes session, medical professionals will have the knowledge and confidence to efficiently and accurately use a defibrillator.
Learning objectives
Learning Objectives:
- Identify the typical equipment and personnel required when applying the defensive on a patient.
- Recognize the environment that is most suitable for applying the defensive on a patient.
- Assess a patient's response to the application of the defensive by monitoring their GCS, perfusio, signs of myocardial ischemia, and pulmonary edema.
- Adjust and calibrate the defensive system components in order to deliver the most effective therapeutic shock to the patient.
- Utilize the defensive system by achieving electrical and mechanical capture in order to stimulate and restore a functional cardiac rhythm.
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Computer generated transcript
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The following transcript was generated automatically from the content and has not been checked or corrected manually.
Thank you. Okay, thanks. Day. And so over the next 20 minutes. Okay, we're gonna talk about the practical sad up on application off using a defense for first of all the Pearson and bradycardia algorithms on. And we will cover a second ized DC shops would happen. Card is everything you're about to here on See me demonstrate It is covered by the resource console and it's so obvious on the band slaves support. So you don't any elasticity a refresher if you haven't done it a little bit in in True as to the standard of what we would expect and the less provider to be able to see our recent us. So I have some resources which I will make available on Madl afterwards. Like the algorithms on where to find the best and training these sources for that south for the the system. So to get us started on what I would like to do is really do. This is a practical demonstration about Hae to set up and it's just the defense I applied onto the patient from here. So if your brother Karthik patient and according to your algorithms should be making a decision based on clinical parameters about whether they're adverse science. The neck desiccation is stable of our system. Stable. Okay, kind of things that the recess kinds of look for in terms of stability is what is the GCS off this patient on What is there a straight a profusion? They're also looking for signs of myocardial ischemia. Be not on the C G changes or ST Depression or ST Elevation. And they're looking for signs of feeling er, which is through pulmonary edema. Flash pulmonary edema on the fourth one just to skip make house in my head. Yes, that's right. Shocks a baby, usually a systolic less than 90 and another person can be less so That will be your first signs on. If you have those on percent, you want to then look to use electrical intervention, speed up for brandy or four packages that for our running cardio patient. And there are a few things that we need to consider in these to be true for any use of the defect that we got in a talking patient, this is not cardiac arrests. We need to be mindful of the environment for where we're going to do this. Ideally, in a resource like environment, you have three on and 60 degree patient access. You need to have the right equipment arrives. So defense, which will go through but also other things for substitution fluids, cannulation monitoring. And I would say to you and title seem to be a must for doing this thing in my department, and we need to think about the personnel involved. You would need to be usually have one magic if not to always a nurse, and ideally and eating are C's. They're really from oversight CFT inscribed Point review, and I can't I can't oversee it. Important it is about you needing are spirt side there accidentally and calls me a long time or Elestrin in, and they will think of them. See if the questions that we, or maybe cognitively, we'll do the bike keepers right. And we also don't think need to think about some of the environment as cheese to be tilting bad. So you go ahead dining of the patient moments. You need to think about having suction available on down also and back up. Where is your nearest help? Is that a consultant on the phone at home. Do they notify before you do this? Because they're sedation involved. And is that another? Is it is that your middle grade are essentially call Take our, um, South. We decide on the flu work you need them involved to be aware of. What's going on with those promises are restless doctors in mind. And when I turned to the defense. So we've assessed location the Bradley Kartik, You do have those up first features and we're in resource may have everything set up. What I need to do this. Let me take you to your defense. There's old defense. They're the same three like the Northern Trust on this is an are serious plus defense. Most importantly, are ones in the social of this in the section of the bottom level trapdoor. Not all defense have them in cause they are ones. Maybe substitute. And this is essential. If you would like to be any clear sense with your patient for about a party, the first thing that we do with any of our comes the defense is a top. Some parts of your issue we're obviously going to defense. Three. Are you Burt? Possible cause of pockets like this often pretty connected on the end of the season. Part placement is here. It's very self explanatory. The pictures are there, actually kick it out of the pocket. Pictures are also on the potty. Okay, It is absolutely acceptable. The pas for guessing a cardioversion just to say despite the triangle on the sternum in the middle of this one on the left. So practical area, you can never put the tape e. And depending on the patient's body habitus or senior doctor bowling preference, you may get better cardioversion piercing, depending on where just put them on like you're doing. CPR has died on the patient, doctor, the longer and then the girl. For all of these procedures, we turn it on here, on the automatically set a CT higher. Turn it the manual mode every time it stops the chart. Not yet gives you control off. What? You're doing the station. Okay, so it'll automatically defaulted parts. Want your parts that active? You can change up by flicking through the different leads. But if you can do on the patient little sense, the part of the machine and I'll come on and as you can see here. We have a broader cardiac patients. You've got a heart. Me? If you have 30 years for those it with a nice thank you. See a pa. We have peewee of peewee of it's disconnected. Somebody three rs. So this is a third degree heart block. Once we have it here, we have a patient on the table with our CFT precautions. And I'm sedition is on board is a must. And then what we're gonna do is and able RPS in function. Okay, you just do it out quickly. Second, going to the PSR option and green on a little trap door opens. And that gives you two little diet on the bottom. Here in the middle, we go eat through each of those in turn. What we have here is two adjustments. The first I will be the millions. I find much electricity. Are you d are you delivering to that patient? Okay, registers on here on the screen. That zero milliamps we're not providing any electricity through the cards in a minute, we could die lot up, and usually I was returned to die and you'll see the numbers went up. The a less algorithm would see it. Usually you get a piercing spike anywhere between 40 and 80 million. It's this is the hand on your patient. But what what we're looking for. I'm just gonna change this by God's, you know, to get your league. So what we're gonna do is we're gonna die lot up, usually somewhere between 40. And you know, you should see your peers and spikes like a ride. Just don't put it the 80 for an eye. The next time it's on here is the really on enormous genes. It defaults to 70. Pulse is for a minute. Okay, so that's just thinking about is your heart yet? Again started Saturday. You could die lot up. What we're hoping to achieve here is that first of all, we will see mechanic, or we'll see electrical capture. So as we die or millions. So we should see this piercing spike with this electrical strike that comes on your screen and that is also delivering electricity through the through the patient. So the patient will be aware of this. This is the importance of sedation. If you want to see the underlying rhythm of the patient, I think the peace expect you have this little 4 to 1. But in the middle, when you press the 41 it should be and stop the piercing for a bite. Four beats and it will show you the underlying rhythm without patient is so You can see when I do start that concert the electrical pulse, just FDA and delivered by the machine for four bits and then not gives you the opportunity to then see the thing underlying rhythm in the patient. Essentially, when you see this, this is called electrical culture and what you would have one here is a peak. Medication isn't. But I am here with ads on you have a colleague, usually your nurse or another medical professional on hand on the radio posts another maybe with the hand on the Chronicles. And what we're trying to do is achieve mechanical captured, so I can you feel it holds. We're trying to generate a pulse in this patient. Do we have enough electricity? They're good enough for you to generate so essentially what we do around on the cults and you're gonna keep tightening up your opportunity here, where the electricity liver to the patient until you get what we call mechanical capture. Okay, 94 holes that's made for generating a cardiac. Usually we would say go 5 to 10. Millions of both were you first, Feeding mechanical capture not just gives you a little bit of leeway A little bit to play, but certainly walking 100 realize again. So the assigning sometimes maybe you wanted a bit faster than we wanted it slower. You can adjust your be accordingly. So wait, look todo anything permanent. Really? At this stage, what you should be finding is with your with your patient who has connected up to the monitor you should see on your monitor. You should see electrical activity. You should have a patient with the cardiac. I couldn't help with the big must. The knee is gonna last in the next office. Is these release? Okay, Comes to piercing. These leads are absolutely essential. They're just like the sleep problem is that on the on the machine? But it's upside of the imperative that these are connected to the vision. The reason being that this is hard machines senses the underlying rhythm vision. So as just like we normally would lemon for left bread for right on degree. Just was one there that so you would connect the multiplication when you do that, that lost machine to sense what your underlying rhythm is for. Today's purpose is gonna connect the molds. Your box. So we got water on the face Studio night. What will happen is you'll have the underlying rhythm. You can see these are the questions. Electrical are the patients. Heartbeat is not followed by are preceded by the electrical stimulus. The dining words were that angular deflection is the electricity generating A curious that tells me we have electrical capture there. If you wanted to see the underlying rhythm, just a So I said before the one button will cut the electrical impulse, like by four beats. And you can see Actually, we're still about complete heart block underneath. But now that we have both electrical capture this time with this reflection with a QRS weight, have a probable pulse mean I have what we call mechanical capture. Okay, so in summary for Pearson, when it comes to the defense, you want to turn it on manual mode turned us to pee, sir, on this little flower Balkans. Okay. You want to have your three leads talks to the patient and you want to dial up your milliamps until you get electrical capture on here on who keep going up until you get mechanical capture. I, er, help a little, but that stage go 10 millions of oh on ensured that that correlates with the patient. So you do have a patient with the cardiac cath report with their title seem to treat us. It's apparent, and hopefully a patient is talking to you all, be it. They are sedated. This is a painful electrical stimulator that's being a 5, 80 times a minute for this patient. They need to have some sedition on board. And that would be someone with army skills, usually fentanyl. Usually somebody has a lot to make it to make it bearable. Some patients that's our piercing and summer. Are you done? Um, any questions? I'm happy to take it the end or put in the chat box. The new can keep you right now is going to go back to start. We will do DC cardioversion. Okay? Yeah, to much like we talked about for our for size. We are not have a patient with a tachycardia way. You have occasion to the topic. Cardio. We have all the same equipment. Uh uh. Resource facilities on our personnel gathered up. We need to go to three a. DC cardioversion. But this is a patient is on for signs. According to the talking party over them again. See him? Idea. We have our defense. We're going to turn it on again. It will default to be a What we're going to do is transfer that higher command your load again, These lights up and it gives us an option at this table so you can see a topic party rhythm one screener brother complex and again, if you have a patient is talking to you, Right. Complex happy. But it's most likely, uh, HVT on. Do you have a patient who is talking to you that has some sedation on board before we're going to start sinking? I shop the key to this. Is this something done here? This synchronized auction on and off for any DC cardioversion we always want to help. Simple. Okay. From the pushing, you can see these little white dots to peer the top of every two rs complex, but not means that the machine can censor Victoria's that liver, the electricity at the appropriate time, the rest feeding If we deliver a trio If we deliver electrical in front of the heart when the heart is Raston, I e. On the team. Leave the parts before. I think you could make things worse with the VFW. So that's why we put simple, um, to the QRs on the electrical cardioversion is delivered at seeing time and therefore the heart is more like either back into normal. Okay, we have our said, but no, we have our patient sedated on then The next option we have for this is decided by our energy. Okay, So you can choose from our energy so that not where we want to start again. A less algorithms, a little teacher by a f on your complex or flutter and narrow complex for DC cardioversion. That's a point when you're doing your area last. We understand the energy's a bowl here and cause weight and esteem will often say starting 120. Okay, so you said that your energy just like lotion, right? Well, this will automatically defaulted 200 for a cardiac arrest. Sweet at the highlight times a 1 20. And then what we have is their charge underactive go administration. Okay, so once we have our sent gone sedated patient Philly monitored with the time saying to with anything with the charge, a little charge arising, told and continues to go. And then the imperative will be to hold your bottom on this part. Okay? The reason being machine has to the liver and shop on the curious on the way dot So you have to hold this in. Usually, I would say my teaching usually say hold it and threw up three seconds. And that gives the machine time to sense on the liver, the shock at the right time. You are expecting it today after your first of all. Okay, so one time tripped up. I'm going to charge up now. I have selective my energy land. Reach a continuous stone 120. Ready? Everybody sound clear. Shocking. Delivered. One two seconds. Three seconds. Shock delivery. And then you want to go back and you want to look at your patient? Are the do you still have an anti? Seem to is a probable cults. Is the SATs broke? Still bleeding and then you want Want you happy? ABC So the patient come back in a month there? Has it worked? Hasn't reverted to your normal Sinus rhythm when narrow contracts happy. And the answer here is no excuse. Okay, So again, if that was the kiss going to cause her any less algorithm in diuretic deal, the next option would used to get it with 1 52 cm process again. So select your energy heater, Jack, your patient A B, C's and times working. You're saying, but it's still on charging you guess? Yeah. Okay. Thank you. Very shopping being delivered. Sound clear. Three again. Stretch your patient. ABC is the entitled Last Testing Chest rising. And is there palpable pulse? All those things are good. Come to your monitor. Yes, we have work. They've got a P followed by a GRS heartbeat called 72. And you can still see the white dog cause bone in your yard. Now it would look like a successful DC cardioversion in this scenario. So to summarize in resource safety personnel approved resuscitate mint for sinusitis. Present acting party over. Then you turn the machine on you return. It's a manual. You're going to use the same problem. Select your energy and then you're going to charge. Deliver the shock. Keeping your finger on the bottom for up to three seconds. Please don't forget the delay, but it doesn't always work straightaway after they smelled then, because you're doing the same thing I started. Once the shark is delivered, once a piercing is initiated, it's all about the patient will back to the patient. A B C's is the airway patent. Is there any time? See you. I put this the chance rising a bowling. Do you have situations? Do you have that information? So it's all about the patient Before you come back, check. I'm gonna stop there. Hopefully in somebody I have covered the basic principles of how to use a defense for Pearson. Um, for DC cardioversion when it comes to passing, it's really important that you have the three needs on This is the most common reason why peace. It doesn't work. So when it gets cold and it for in the morning because pas and wives will work necessary These you have not connected with these medications. Okay. Must must must be a little patient. See him when the coast in DC Cardioversion for concrete body is you have to have safe. Okay. Have to have the weight starts chewing gum. It's not their don't past about, okay, Please send you on for the taxis. The three leads, all for the bad part is Thank you. Take questions. Susan are as asked. It might be a silly question. Which raisins are What would you do in the event of maybe overnight? Where there wasn't a member of staff in the 80 with a weight training? Would you initially conduct anesthetics, or would you wait for the consultant to come in if that wasn't it? Okay. Great questions are so and he didn't find yourselves, not surgery issue. Sometimes company did. I would say, if you have a second a shinin the department that you're worried about any sense your left on the phone on the first one called Toujeo. More than happy to hear from you on any seeds in their night. If you're worried about finished and if you find you have a patient that's an extremist, you just a tear eating you're worried about. You will get a static help, Escapee. They are in the building 24 7. I would say That's three phone calls. It's one pill like us on one toe statics. They will probably come down to the department, give you a hand for the initial period when the consult, their eyes will be there to back them up. And we're outside of college. Excellent. More than happy the facility that in drum before we can come in. So those are absolutely fooling us. And after what happens is you may be on the phone and, um, statics ancestor of the Nurse Society can. For us, it's very quick Once, once you speak just it's like all my needed to come in. We're on the way, so there's no way she without and certain questions and carry she's asking overnight. Do we have to inform the uncle consultant of the DC cardioversion of being carditis recess? Okay, good question is well, so I would say to you, that's just if you have an easy person. Eller was met nursing a medical, and you're happy? Probably capable. Done it before I have this process properly again. Like I said, this is sedation. So you wanna have sedation performing all of the six touch I really on. But you're gonna have your ls. Accreditation. If in any stage of the Maddox or the nurses are happy you for us, we come in, we give it vice. So if you think should I start taking something that means you should This is a thanks so much. Thanks very much. Call him.