Dangers of defibrillation

Onlookers and assistants should be asked to stand back during defibrillation to avoid electrocution. Smearing electrode jelly on the chest can result in surface current arcing between electrodes, burning the skin as well as failing to defibrillate. Burns may also occur if there is inadequate conductive material between paddle and skin. Nitrate patches under electrodes and oxygen administration have been reported as causes of fire.

Failure to defibrillate may be due to inadequate current flow and mandates changing to an anteroposterior position of the electrodes (left precordium and right infrascapular region), change of defibrillator, or techniques such as intracardiac or transesophageal defibrillation. Excessive current flow may cause myocardial necrosis.

In the presence of indwelling pacemakers, defibrillation may cause damage to the myocardium as current traverses the pacing electrode causing burns at the tip of the pacing wire. This may cause a rise in pacing threshold. The generator itself may need reprogramming after defibrillation. To minimize damage, the defibrillator paddles should be placed at least 12.5 cm (one paddle width) from the generator.

Finally, defibrillators may not work owing to poor maintenance, inadequate checks, or unfamiliarity with the instrument ( C.ummln.s.et,a.( 1990). The solutions are obvious but can be difficult to implement.

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