# Manual Defibrillation

## Overview

This module describes how to perform manual defibrillation as part of cardiopulmonary resuscitation.

## Indications

## Contraindications

## Patient information and consent

This procedure is done when a patient is in cardiac arrest, so consent is generally implied. However, check for “Do Not Resuscitate” (DNR) orders, “Not For Max” orders, or living wills that specify that no resuscitation may be performed.

## Preparation

Manual defibrillation is an emergency procedure. Always:

## Site & Positioning

To perform manual defibrillation, a patient should be lying flat on their back on a firm surface with their chest exposed. All clothes, including undergarments, should be removed from the chest.

## Procedure

Follow medical asepsis with non-sterile gloves. Do not interrupt chest compressions until completely necessary. This procedure is a part of basic or advanced cardiac life support. The description below assumes that the patient is

not yet connected

not yet connected

If the patient already has ECG monitoring leads in place, it is not necessary to switch to Paddles mode.

to ECG monitoring.

####

#### Defibrillator with paddles:

####

#### Defibrillator with pads:

## Troubleshooting

The patient has a lot of breast tissue.

Always try to place pads under or lateral to breasts. Large breasts can compromise the effectiveness of the shock delivered.

My patient is soaking wet.

Wipe the patient down quickly before applying pads.

My patient is so hairy I can’t get contact with the skin.

Use a razor to shave the contact areas, or use any kind of adhesive dressing or pads to “wax” off the worst of the body hair.

My patient is wearing an underwire bra.

Cut it off. The current can run through the underwires, rendering it ineffective, and can cause burns.

My patient has a medication patch on their chest.

Remove it and wipe the area quickly.

My patient has an implanted pacemaker or defibrillator.

Don’t be deterred, but avoid placing your paddles on the device.

The screen keeps showing asystole.

Press the Gain button several times to enlarge the ECG displayed. You may have a very low amplitude rhythm you just can’t see at the current level of gain.

Where do I place the three leads?

“Red on the right, green on the spleen, and what’s left on the left.” Place the red electrode on the right shoulder, yellow electrode on the left shoulder, and green electrode on the lower left torso.

I’ve charged, but I decided I don’t need to shock.

Ask an assistant to turn the defibrillator to Monitor instead of Defibrillation. This safely dumps the charge. Do not move charged paddles from the patient’s chest.

How do I keep myself and my colleagues safe from electrical accidents?

Always shout “Clear!” before shocking.

Always keep oxygen sources at least an arm’s length away (oxygen + electricity can cause explosions).

Paddles should always be firmly on the patient’s chest, or placed in their rests on the machine. Don’t put paddles down anywhere else.

Never hold both paddles in one hand.

## Risks

## References