Practical external defibrillation

The electrodes are usually applied below the right clavicle to the right of the sternum (bone is a poor conductor) and apical (fifth left intercostal space in the mid-clavicular to mid-axillary line). Electrodes or pads of diameter 13 cm are suitable for adults; electrodes of diameters 8 cm and 4.5 cm are suitable for children and infants respectively. Energy requirements depend on patient size. An initial shock of 200 J is recommended for a 70-kg adult; 2 J/kg is a useful estimate for smaller patients. Therefore a 10-kg child (about 1 year old) would need 20 J. Pediatric paddles are probably too small for a patient of this size, producing high impedances and inadequate defibrillation current. An electrode of larger diameter should be selected ( Aik!Q.S e.t,al 1988).

The success of the cardiopulmonary resuscitation sequence depends on basic life support and then early defibrillation at 200, 200, and 360 J. If defibrillation is unsuccessful, intubation, ventilation, intravenous access, adrenaline (epinephrine), and external chest compressions are resumed. Initial cardiac output may be low after successful defibrillation and may only improve slowly.

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