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Defibrillation: Procedure, Indications, Devices & Chain of Survival

Definition

Defibrillation is the delivery of a controlled electrical shock to the heart to terminate life-threatening ventricular arrhythmias and allow the sinus node to re-establish organized rhythm.

Indications (Shockable Rhythms)

  • Ventricular Fibrillation (VF) – chaotic, no effective contraction.
  • Pulseless Ventricular Tachycardia (pVT) – wide-complex tachycardia without pulse.

Devices

TypeDescriptionUsers
Manual External DefibrillatorOperator interprets rhythm, selects energy, delivers shockACLS providers (paramedics, nurses, physicians)
Automated External Defibrillator (AED)Analyzes rhythm, advises shock, delivers automatically/semi-autoLay rescuers, first responders, public access
Implantable Cardioverter-Defibrillator (ICD)Surgically implanted; continuous monitoring, auto-shock for VF/VTPatients at high sudden cardiac death risk
Wearable Cardioverter Defibrillator (WCD)External vest with sensors; temporary protectionBridge to ICD, post-MI, newly diagnosed cardiomyopathy

Energy & Waveform

  • Biphasic (standard): 120–200 J (adult), 2–4 J/kg (pediatric). Lower energy, higher first-shock success.
  • Monophasic (legacy): 360 J fixed.

Chain of Survival

  1. Early recognition & EMS activation
  2. Early high-quality CPR
  3. Early defibrillation (critical – survival ↓ 7–10%/min delay)
  4. Advanced life support & post-cardiac arrest care

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