The countershock, to be exact its version - an electric defibrillation is one of the main resuscitation actions at sudden death. It is known that fibrillation of ventricles is the most frequent reason of a cardiac standstill. Proceeding from it, the result of resuscitation often depends on a possibility of the fastest carrying out a defibrillation.
If the adult patient has a cardiac standstill, and the defibrillator is available in immediate availability, it is expedient to use him as soon as possible. If the cardiac standstill occurred without witnesses or the defibrillator is inaccessible, it is expedient to begin carrying out a complex of the cardiopulmonary resuscitation (CR), in parallel being engaged in search of a defibrillator for evaluating a rhythm and drawing the category if it is necessary.
Practically carrying out a defibrillation at SLR looks as follows. Continuing to carry out a cardiac massage, on a thorax of the patient put plates of a defibrillator or paste self-adhesive electrodes of a defibrillator and quickly estimate cordial ̆ a rhythm. Assessment of a warm rhythm from plates or self-adhesive electrodes of a defibrillator occurs quicker, than registration of an ECG. For a short time interrupt compressions chest ̆ cells for rhythm assessment. Indications to carrying out a defibrillation are fibrillation of ventricles and ventricular tachycardia without pulse. The asystolia and electromechanical dissociation are not indications to carrying out a defibrillation.
The applicability of a dvoinoa ̆ consecutive ̆ defibrillations at an ustoichivy shock rhythm was not proved. The Dvoiny consecutive defibrillation is almost simultaneous use of two categories with use of two defibrillators. Though favorable outcomes are mentioned in some reports, systematic ̆ the overview of 2020 did not find proofs in support of a dvoinoa ̆ consecutive ̆ defibrillations and did not recommend its use in routine ̆ medical ̆ to practice. The existing researches are subject to various system mistakes, and observation researches did not show improvement ̆ an outcome.
When using a manual defibrillator: load a defibrillator (make a set of a charge), then stop compressions and put one category then immediately continue compressions. Carrying out a defibrillation should not interfere with performance qualitative compressions; pauses between a stop ̆ and resuming of a compression ̆ have to make no more than 5 seconds. Level necessary ̆ energy for each concrete defibrillator is determined by its instruction ̆ by operation. Usually for a bi-phase defibrillator the level of the first category is not less than 150 J, for monophase — 360 J. Before drawing the category it is necessary to be convinced that nobody touches the patient. Medical ̆ the worker who is carrying out ̆ a defibrillation directs deistviye resuscitation ̆ crews.
It must be kept in mind that medical viewing gloves do not provide protection of personnel against defeat with electric current when drawing the category.
When using an automatic external defibrillator (further — the ANDES) follow its instructions, trying to minimize pauses in compressions.
After performance of a defibrillation of SLR continue to carry out within 2 minutes, then again quickly estimate cordial ̆ a rhythm. In case of preservation of fibrillation of ventricles or ventricular tachycardia without pulse put repeated ̆ the category (150–200 J for a bi-phase defibrillator or 360 J for monophase), then immediately renew SLR (without pause for repeated ̆ estimates of a rhythm and definition of pulse), since a compression ̆ chest ̆ cells (a ratio with artificial breaths 30:2). Continue SLR within 2 minutes, then quickly estimate a rhythm. At preservation of fibrillation of ventricles or ventricular tachycardia without pulse put the 3rd ̆ the category (150–200 J for a bi-phase defibrillator or 360 J for monophase). Then immediately renew SLR (without pause for repeated ̆ estimates of a rhythm and definition of pulse), since a compression ̆ chest ̆ cells (a ratio with artificial breaths 30:2).
In the absence of restoration cordial ̆ activity after the 3rd category in the presence of venous (or intra bone) access enter 1 mg of Epinephrinum (can improve a blood stream in a myocardium and increase chances of success of the subsequent category) and 300 mg of Amiodaronum. Medicines enter bolyusno in cultivation on 10 ml 0.9% of solution of sodium of chloride or against the background of infusion of solutions.
Introduction of Epinephrinum in a dose of 1 mg repeat after every 2 cycles SLR (each 3–5 minutes) before emergence of signs of life in the patient or ascertaining biological ̆ death.
The following introduction of Amiodaronum in a dose of 150 mg perhaps later the 5th ̆ attempts of a defibrillation. In the absence of Amiodaronum enter lidocaine in a dose of 1 mg/kg (it is not necessary to enter lidocaine if already entered Amiodaronum). In case of persistent ̆ fibrillations of ventricles or ventricular tachycardia without pulse exclude the possible reversible reasons of a cardiac standstill.