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cause and effect essay topic 45 an icd is a device that provides internal electrical cardioversion of vt or defibrillation of vf. The icd does not prevent the patient from developing the arrhythmia, but it reduces the risk that the patient will die of sudden cardiac death as a result of the arrhythmia. Whereas early versions of icds required a thoracotomy for implantation, these devices now may be implanted transvenously, similarly to pacemakers, markedly reducing the incidence of complications. Icds are significantly more effective than antiarrhythmic drugs such as amiodarone or sotalol for reducing the risk of sudden cardiac death, and therefore are preferred therapy. 45–47 however, many patients with icds receive concurrent antiarrhythmic drug therapy to reduce the frequency with which patients experience the discomfort of shocks and to prolong battery life of the devices. Combined pharmacotherapy with amiodarone and a β-blocker is more effective than monotherapy with sotalol or β-blockers for reduction in the frequency of icd shocks. 48 »» outcome evaluation •• monitor patients for termination of vt and restoration of normal sinus rhythm. •• monitor patients for adverse effects of antiarrhythmic drugs (see table 9–7). Ventricular fibrillation vf is irregular, disorganized, chaotic electrical activity in the ventricles resulting in absence of ventricular depolarizations, and consequently, lack of pulse, cardiac output, and blood pressure. »» epidemiology and etiology approximately 400,000 people die of sudden cardiac death annually in the united states. Although some of these deaths occur as a result of asystole, the majority occur as a result of primary vf or vt that degenerates into vf. Etiologies of vf are presented in table 9–12 and are similar to those of vt. »» »» clinical presentation and diagnosis of vf symptoms •• vf results in immediate loss of pulse and blood pressure. Patients who are in the standing position at the onset of vf suddenly and immediately collapse to the ground diagnosis •• the absence of a pulse does not guarantee vf because pulse may also be absent in patients with asystole, vt, or pulseless electrical activity •• confirmation of the diagnosis with an ecg is necessary to determine appropriate treatment. Ecg reveals no organized, recognizable qrs complexes. If treatment is not initiated within a few minutes, death will occur, or at best, resuscitation of the patient with permanent anoxic brain injury treatment desired outcomes  desired outcomes are to. (a) terminate vf, (b) achieve return of spontaneous circulation, and (c) achieve patient survival to hospital admission (in those with out-ofhospital cardiac arrest) and to hospital discharge. Pharmacologic and nonpharmacologic therapy  vf is by definition hemodynamically unstable, due to the absence of a pulse and blood pressure. Initial management includes provision of basic life support, including calling for help and initiation of cardiopulmonary resuscitation (cpr). 11 oxygen should be administered as soon as it is available. Most importantly, defibrillation should be performed as soon as possible. It is critically important to understand that the only means of successfully terminating vf and restoring sinus rhythm is electrical defibrillation. Defibrillation should be attempted using 360 j for monophasic defibrillators, and 120 to 200 j for biphasic shocks, after which cpr should be resumed immediately while the defibrillator charges.

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