Talk:Defibrillation

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[edit] Background Info

The background info is from some of my papers. It needs editing and linking to other headings which I plan to do. Comments much valued. Dokane 17:15, 3 Oct 2004 (UTC)

Regrettably I've had to remove this very unwieldy strech of text. The references are incomplete (no journal mentioned), and there are no Wikilinks.
The article should have more info on the background of defibrillation, but I think it should be more concise (the average reader doesn't want detailed animal studies etc). I have copied it all to my Notepad and I'll see if I can turn this material into something useful.
It seems User:Dokane has left Wikipedia. I've sent him an email. JFW | T@lk 20:57, 30 Dec 2004 (UTC)

I would like to see a lot more about the histroy.

[edit] The defribillation example picture

This might seem frivilous. Maybe you could find a picture of a person whom the defribillator is used on, that isn't where the person is a topless woman. I just think it's kind of unecessary to have a picture like that when there must be one, with a guy in it. I mean, there's no sense in making it sexualized. Violet yoshi 06:18, 31 December 2006 (UTC)

The sexualization is in your head, not in the picture.

That picture is appallingly inaccurate, and certainly not "typical". At least two people are require to use a BVM effectively, even an "anaesthetists grip" isn't as effective. The display from the AED is away from the paramedic and although described as AEDs they are actually semi-automatic...someone has to initiate the shock! The other person must be painting the picture (sarcasm!) Also, the BVM looks like it is connected to oxygen...very dangerous if defibrillation is in progress --> should be removed from the immediate area. Next time I have a free minute on nightshift I and my colleagues will take a real picture of defibrillation/resuscitation in progress. —Preceding unsigned comment added by Panthro (talk • contribs) 15:11, 10 October 2007 (UTC)

Whilst I agree that the picture isn't of the highest quality, I'd say that it is pretty typical of a resus in progress in the pre-hospital care field. BVM is really only trained for single operator us in ambulance care (using the anaesthetists grip), and whilst we know that you 'could' do it with two people, generally, they have better things to be doing. Your average crew of two has one crew member looking after the head end, including airway managment and BVM, whilst the other sorts out chest compressions and defib (and either or both try and get the cannulation done where appropriate). For the solo responder (like me), i have to try and do it all from the head, including BVM, defib, airway etc. - so is this typical? I'd say very much. Given the position of the defib in the picture, i'd say it is facing the person whose 'view' you are looking at. Oh, and lastly, of course the BVM is connected to oxygen - that is standard practice - you simply move the BVM away from the patient when applying a shock. Owain.davies 06:26, 11 October 2007 (UTC)

As someone who doesn't know a who lot about defib, this picture is not very helpful. The artistic redition is hard to make sense of. Plus the boobs are discracting. I'm sorry but they are. It just seems unnecessary. —Preceding unsigned comment added by 71.135.43.2 (talk) 22:31, 2 February 2008 (UTC)

I really see no reason to have a topless woman in a scholarly encyclopedia webpage. Children use wikipedia, too. —Preceding unsigned comment added by Sswan (talk • contribs) 14:23, 20 February 2008 (UTC)

You know what? The defibrillator in the picture looks like a Super Nintendo. Is that supposed to be a joke? 99.234.35.141 (talk) 16:20, 5 May 2008 (UTC)

Yes, that is a SNES. a Super Famicom JR to be exact (it shouldn't have that cartridge, though) http://en.wikipedia.org/wiki/Image:CPR-oxygen-defibrillator.jpg the original. I don't have any problem with the SNES though. it is amusing —Preceding unsigned comment added by Manofiorn (talk • contribs) 03:02, 12 May 2008 (UTC)

I found it highly amusing that two of you complained about the nude breasts AFTER my childish MS Paint hackery, failing to notice she had a VIDEOGAME SYSTEM hooked up to her "boobs." I was rather hoping that this would go unnoticed for a while longer - my friends and I were keeping an eye on the article and placing bets. Well at least it lasted far longer than my Dogs Portal.jpg on Portal:Dogs did. Note: the label on the EMT's uniform should read SMUR for Service Mobile d'Urgence et de Réanimation ("Emergency and Ressucitation Mobile Service.") At my friends' behest I changed this to WMUR, my friend's blog name and former IRC channel, which I assume is a play on his name and local college station WNUR. Snorks1234 (talk) 19:58, 15 May 2008 (UTC)

Also lulzy is Violet yoshi's misspelling of the words "defribillation," "frivilous," "defribillator" and "unecessary" - get spellcheck honey, quit relying on so many badly translated Japanese videogames for your vocabulary building. Besides, nude breasts are only sexualized in puritanical American culture, they're perfectly acceptable in other parts of the world.

71.135.43.2 - "redition," "discracting?" Well at least you got "unnecessary" correct. But, "boobs?" Please. Are you 13?

Sswan: Again, perhaps exposing children to non-sexualized nude breasts "in a scholarly encyclopedia webpage" will help to combat the ridiculous American sexualization of non-sexual mammary organs. I mean, would you expect pictures of female apes on Wikipedia to require they wear brassieres? Would you? Snorks1234 (talk) 20:13, 15 May 2008 (UTC)

Oh, by the way, Manofiorn, the SNES 2 console exterior was virtually identical to the SFC Jr. Only difference was that it had purple buttons and of course accepted North American cartridges instead of Japanese/European. http://www.old-computers.com/museum/photos/nintendo_snes2_1.jpg Someone asked me what game was in the console - since I never considered that when I "drew" it, I answered Super Castlevania 4. Snorks1234 (talk) 04:07, 16 May 2008 (UTC)

[edit] Comment removed from article

"(The AHA also applies this new protocol to manual defibrillation, though without evidence or rationale.)"<ref>2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiac care. Part 5: Electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing. Circulation 2005; 112 [Suppl I]:IV-35 - IV-46. Article</ref>
  • I don't understand this apparent slam to the AHA (which is original research in the absence of a valid reference). There is a rationale. And it is based upon the prevailing science. The modern biphasic waveform has a high first shock efficacy for terminating VF. Studies have shown that CPR prior to defib (with down times > 4 min. when CPR has not been performed prior to the defib's arrival -- the vast majority of sudden cardiac deaths in the community) significantly increase odds of successful defibrillation and confers a survival benefit. Repeated shocks without CPR in between (ventricular rates with VF are > 600 which uses up a lot of ATP and produces a lot of waste products in the surrounding tissue) does nothing but stun the myocardium. You have to wash out the metabolites. Show me the evidence that stacked biphasic shocks increase the odds of survival. I suspect you won't find any. Best, MoodyGroove 17:59, 7 March 2007 (UTC)MoodyGroove

Reply:

Read the reference I cited in the Guidelines. Do you see any evidence or rationale for applying the new protocol to manual defibrillation? I don't. The AHA is attempting to correct a problem with AEDs: the pauses without chest compressions before and after shocks that were required by the old AED algorithms. There is nothing about a required interval of CPR before the first shock, which would be relevant to the time-phase model of cardiac arrest that you seem to be referring to. The new guideline appears to assume that everyone is using biphasic AEDs, which hardly reflects reality. If the AHA is saying that this guideline is applicable to downtimes longer than four to five minutes, they should say so--but they don't. Your perspective is formed by responding to out-of-hospital arrests, where I'm sure downtimes must usually be greater than four or five minutes; mine is the perspective of a hospital nurse, where time from a witnessed arrest to first shock of more than four minutes is in my view unacceptable--though sadly it is frequently the case.

That said, I don't object to deleting the sentence. I'll make the point in an upcoming letter in Circulation. texasex 00:51, 20 March 2007 (UTC)

  • If I remember correctly, it takes about 15 compressions to build up adequate coronary perfusion pressure. Every time you stop compressions (for any reason) you have to start back again at zero. So it's clear that interruptions to chest compressions (even for ventilations) should be minimized. We know that biphasic waveforms have a high first shock efficacy and we know that ILCOR/AHA/ERC is recommending starting out right at 360J for monophasic waveforms. If that doesn't terminate VF, why continue to insult the myocardium with repeated shocks when it was not receptive to the first shock? Change the substrate. Studies have shown that 100-300 compressions (2-3 min. of CPR) prior to defib can make shocks more effective. The electrical phase of the arrest only lasts for about 4 minutes from the moment of collapse. There was a rationale for eliminating stacked shocks (and let's not forget, there probably wasn't a whole lot of evidence supporting stacked shocks in the first place). I thought they did a fantastic job with ECC 2005. But I'd be happy to read your letter. Best MoodyGroove 00:07, 22 March 2007 (UTC)MoodyGroove

[edit] Proposed merge Defibrillator with Defibrillation

I appreciate that this has been discussed before, but it was 2 years ago, and since then, there has been little divergence in the articles, and i think there is a strong case for merging them. I have done a basis for the updated page in my sandbox: User:Owain.davies/Defibrillation

Please have a look before making a decision, but i think that the new combined article brings it altogether in a much better format. A few improvements, and i think this could then be a GA grade candidate, which seems unlikely for either of the existing articles.

I would suggest leaving the Implantable cardioverter-defibrillator page, and for the moment the Automated external defibrillator page, but just merging Defibrillator in to Defibrillation, with the latter being the main page.

Comments please (if i don't get any, i'll do it in a week or so)

Owain.davies 08:51, 29 April 2007 (UTC)

  • Support. There are some factual errors in your sandbox version (for example, the heart's natural pacemaker is not the medulla oblongata) and I would recommend renaming the AICD section ICD, but overall I like the length and format of the merged articles. Rather than having a separate article called defibrillator, I'd rather have one article named defibrillation, and separate articles for public access defibrillation and ICDs. Debatable as to whether or not we need a section explaining how to to use a defibrillator, and overall I think the "in popular culture" sections do not add much to medicle articles, but these are all issues that can be discussed and/or corrected after the merge. MoodyGroove 11:53, 29 April 2007 (UTC)MoodyGroove

In the absence of any negative comment, and the support of two good wiki editors, merge now completed. Thanks for your input. Owain.davies 17:04, 2 May 2007 (UTC)

[edit] A possible minor change to the "The change to a biphasic waveform" section

At the end of this section it's said "(VF) could persist in about 40% of cardiac arrest patients" where as in the next sentence, in comparison, it says "Most biphasic defibrillators have a first shock success rate . . . of greater than 90%." Both statistics, to be clear I think, should stick to either failure rate or success rate. So 60% to 90% or 40% to 10%. The way it is seems, to me, to be favouring the new "biphasic waveform" over the old in presentation rather than simply with the facts.

Support - My preference would be for 60%/90% effective Owain.davies 05:24, 23 May 2007 (UTC)
Done! - Completed the change. Owain.davies 16:55, 15 June 2007 (UTC)

[edit] Popular culture section

This section was removed recently by an editor, and i just wanted to discuss it before removing such a large section. The justification given was that use of pop culture references is only useful when the subject is defined by them, when it isn't for defibrillation. (i'm paraphrasing here, but the exact text is in the page history)

Whilst the comment is valid, i think that defibrillation, and peoples' understanding of it, is very much influenced by a lot of the examples given in this section. For instance, movies such as flatliners (and numerous others in the section) foster the impression amongst people to this day that asystole is a shockable rhythm, and that the defibrillator has a huge success rate.

Rather than removing it, if everyone agrees that it should go, i think it would be better recrafted in to a section about the discrepancy between reality and portrayal in the media. Any thoughts?

Owain.davies 07:55, 28 August 2007 (UTC)

The problem with repurposing it is that without citing reliable sources which also contrast reality to the movies this would be WP:SYN. For now, simply removing the more useless examples (Battlefield and Bond for instance) would be a good idea. Chris Cunningham 08:09, 28 August 2007 (UTC)

[edit] Circuit Diagram

In the circuit diagram, what's the inverted T's (there's three of them)? I can't find any reference to them, either on wikipedia or a (arguably shallow) google search. 90.230.54.138 (talk) 15:22, 22 April 2008 (UTC)

Anyone? 90.230.54.138 (talk) 09:29, 15 May 2008 (UTC)
They are switches. OwainDavies (about)(talk) edited at 15:12, 15 May 2008 (UTC)