TMBU Lifepak 20 quick guide for use in manual mode for neonates:

TMBU Lifepak 20 quick guide for use in manual mode for neonates:
Lifepak 20 quick guide to neonatal/paediatric synchronised
cardioversion (for staff already trained in cardioversion)
1.
NB Ensure appropriate sedation/anaesthesia and airway management
2.
Unplug the grey end of the defibrillator lead from the black test plug
 The defibrillator lead is front right and is the thicker of the two leads
3.
Turn on the defibrillator by pressing button 1, marked “ ON ”
4.
Push the grey tab marked “ MANUAL ” to the right and pull open the door
5.
Using button 2, marked “ ENERGY SELECT ” adjust the energy
 First shock: 0.5 - 1 joule per Kg
 Second and subsequent shocks: 2 joules per Kg
 Press the down arrow part of the button to reduce the energy
 If necessary round up to the next energy level and note that the lowest available is 2j
6.
Apply defibrillator pads to the patient and plug the connector into the grey end of
the defibrillator lead
 Child sized pads should be used for neonates (and children up to 15 Kg)
 Adult sized pads for adults and children over 15 Kg
7.
Turn on synchronisation by pressing the button marked “ SYNC ”
 NB After a synchronised shock is delivered the SYNC function turns off so you must press SYNC prior to
each synchronised shock
8.
Visually confirm synchronisation
 A blinking green light on the actual SYNC button (this blinks each time a QRS complex is detected)
 Triangular “sense markers”
appear above QRS complexes
 If there are no triangles skip to 11 below
9.
Warn staff to remove any free flowing oxygen and stand clear, then charge the
defibrillator using button 3, marked “ CHARGE ”
 Once charged a continuous two tone alarm sounds
10. Ensure everyone is clear of the patient, bed, etc and oxygen has been removed and
then push AND HOLD
11. If the defibrillator cannot synchronise it will not deliver the shock
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If charged, press the speed dial to disarm the defibrillator!
Attach the 3 lead cable and note that the current lead is displayed in the top left of the screen
Change lead by pressing the button marked “ LEAD ” (pressing again will jump to the next lead)
Choose the lead with the biggest QRS complexes then go back to 8.
Disarming the defibrillator:
“Press speed dial to disarm” is displayed whenever the defibrillator is charged. The speed dial is the round
button, middle bottom, below the label “Speed Dial”.
Resuscitation Services Department (RSD), January 2015
Complies with Resuscitation Council Guidelines 2010 and advice from Physio Control
Contact the RSD on ext 4579 (RSCH) or ext 5776 (PRH) for further information
Lifepak 20 quick guide to neonatal/paediatric synchronised
cardioversion (for staff already trained in cardioversion)
Notes about cardioversion and use of the 3 Lead cable
When attempting synchronised cardioversion the Lifepak 20 will sense through the default
lead or the lead set by the user.
The default lead is called “Paddles” (for historical reasons) and actually refers to the therapy
pads as opposed to the 3 lead ECG cable (which can display Leads I, II or III). So, in total,
available views are Paddles, Lead I, II, III and a combined Paddles and Lead II.
To both sense and deliver synchronised shocks with therapy pads, Physio Control recommend
that the therapy pads are placed anterior-laterally. In this position the therapy pads show a
view that is, essentially, the same as Lead II. Lead II typically shows the biggest QRS
complexes thus making it more likely that the defibrillator will be able to detect them and
synchronise. This is all well and good on an adult or large child.
However, to avoid a “short circuit” there should be at least a 2.5cm gap between therapy
pads and this will usually preclude anterior-lateral placement on a neonate or infant (as the
pads could touch or even overlap). In this case therapy pads should be placed anteriorposterior. The disadvantage of anterior-posterior pad placement is that the QRS complexes
may not be as easy for the defibrillator to sense and this may hinder or prevent
synchronisation. In this case a solution is to add the 3 Lead and switch to (typically) Lead II.
In short, putting the 3 Lead on and actively changing Leads to find the best view may be of
immense benefit. In contrast, routinely putting the 3 Lead on without actually changing Leads
to look at Lead I, II or III serves no purpose.
Energy levels in Paediatrics
The European Resuscitation Council and the Resuscitation Council (UK) guidelines as per the
European Paediatric Life Support manual, Third Edition (2011), suggest an initial shock at
0.5-1 joule per Kg and up to 2 joules per Kg if this does not work.
The Advanced Life Support Group guidelines as per the Advanced Paediatric Life Support
manual, Fifth Edition (2011), suggests an initial shock at 1 joule per Kg and 2 joules per Kg if
this does not work.
The practical limitations with the Lifepak 20 are that the minimum energy level is 2 joules,
with 1 joule increments up to 10 joules, and larger increments thereafter. So it is unlikely
that an absolute energy level of 0.5 joules per Kg will be achievable. Rather, it would seem
sensible to set the first energy level to a number that falls in the range of 0.5-1 joule per Kg.
And for neonates less than 2 Kg even this 0.5-1 joule per Kg will not be possible. Therefore it
remains a clinical decision based on the condition of the neonate in balance with other
treatment options.
Resuscitation Services Department (RSD), January 2015
Complies with Resuscitation Council Guidelines 2010 and advice from Physio Control
Contact the RSD on ext 4579 (RSCH) or ext 5776 (PRH) for further information
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