Typical view of defibrillation in progress, with the operator at the head.

Defibrillation is the definitive treatment for the life-threatening cardiac arrhythmias ventricular fibrillation and pulseless ventricular tachycardia. Ventricular fibrillation ( V-fib or VF) is a condition in which there is uncoordinated contraction of the Cardiac muscle of the ventricles in the Ventricular tachycardia ( V-tach or VT) is a Tachycardia, or fast heart rhythm that originates in one of the ventricles of the Heart Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator. This depolarizes a critical mass of the heart muscle, terminates the arrhythmia, and allows normal sinus rhythm to be reestablished by the body's natural pacemaker, in the sinoatrial node of the heart. The normal electrical conduction in the heart allows the impulse that is generated by the Sinoatrial node (SA node of the Heart to be propagated to (and stimulate the The contractions of the Heart are controlled by chemical impulses which fire at a rate which controls the beat of the heart The Sinoatrial node (abbreviated SA node or SAN, also called the sinus node) is the impulse generating (pacemaker tissue located in the Right atrium

Defibrillators can be external, transvenous, or implanted, depending on the type of device used. Some external units, known as automated external defibrillators (AEDs), automate the diagnosis of treatable rhythms, meaning that lay responders or bystanders are able to use them successfully with little, or in some cases no, training.

History

Defibrillation was first demonstrated in 1899 by Prevost and Batelli, two physiologists from University of Geneva, Switzerland. Physiology (from Greek grc φύσις physis, "nature origin" and grc -λογία -logia) is the study of the mechanical physical The University of Geneva (Université de Genève is a university in Geneva, Switzerland. They discovered that small electric shocks could induce ventricular fibrillation in dogs, and that larger charges would reverse the condition.

The first use on a human was in 1947 by Claude Beck,^[1] professor of surgery at Case Western Reserve University. Beck's theory was that ventricular fibrillation often occurred in hearts which were fundamentally healthy, in his terms "Heart too good to die", and that there must be a way of saving them. Beck first used the technique successfully on a 14 year old boy who was being operated on for a congenital chest defect. The boy's chest was surgically opened, and manual cardiac massage was undertaken for 45 minutes until the arrival of the defibrillator. Beck used internal paddles either side of the heart, along with procaine amide, a heart drug, and achieved return of normal sinus rhythm. The normal electrical conduction in the heart allows the impulse that is generated by the Sinoatrial node (SA node of the Heart to be propagated to (and stimulate the

These early defibrillators used the alternating current from a power socket, transformed from the 110-240 volts available in the line, up to between 300 and 1000 volts, to the exposed heart by way of 'paddle' type electrodes. The technique was often ineffective in reverting VF while morphological studies showed damage to the cells of the heart muscle post mortem. The nature of the AC machine with a large transformer also made these units very hard to transport, and they tended to be large units on wheels.

Closed-chest method

Until the early 1950s, defibrillation of the heart was possible only when the chest cavity was open during surgery. The technique used an alternating current from a 300 or greater volt source delivered to the sides of the exposed heart by 'paddle' electrodes where each electrode was a flat or slightly concave metal plate of about 40 mm diameter. An alternating current ( AC) is an Electric current whose direction reverses cyclically as opposed to Direct current, whose direction remains constant The volt (symbol V) is the SI derived unit of electric Potential difference or Electromotive force. The closed-chest defibrillator device which applied an alternating current of greater than 1000 volts, conducted by means of externally applied electrodes through the chest cage to the heart, was pioneered by Dr V. Eskin with assistance by A. Klimov in Frunze, USSR in mid 1950s. ^[2]

Move to direct current

A circuit diagram showing the simplest (non-electronically controlled) defibrillator design, depending on the inductor (damping), producing a Lown, Edmark or Gurvich Waveform

In 1959 Bernard Lown commenced research into an alternative technique which involved charging of a bank of capacitors to approximately 1000 volts with an energy content of 100-200 joules then delivering the charge through an inductance such as to produce a heavily damped sinusoidal wave of finite duration (~5 milliseconds) to the heart by way of 'paddle' electrodes. Bernard Lown, MD (born June 7, 1921) is the original developer of the Defibrillator and is an internationally known Peace activist A capacitor is a passive electrical component that can store Energy in the Electric field between a pair of conductors In Physics and other Sciences energy (from the Greek grc ἐνέργεια - Energeia, "activity operation" from grc ἐνεργός The joule (written in lower case ˈdʒuːl or /ˈdʒaʊl/ (symbol J) is the SI unit of Energy measuring heat, Electricity A millisecond (from Milli- and Second; abbreviation ms is one thousandth of a Second. The work of Lown was taken to clinical application by engineer Barouh Berkovits with his "cardioverter". Barouh Berkovits is one of the pioneers of Bio-engineering particularly the cardiac Defibrillator and artificial Cardiac pacemaker.

The Lown waveform, as it was known, was the standard for defibrillation until the late 1980s when numerous studies showed that a biphasic truncated waveform (BTE) was equally efficacious while requiring the delivery of lower levels of energy to produce defibrillation. A side effect was a significant reduction in weight of the machine. The BTE waveform, combined with automatic measurement of transthoracic impedance is the basis for modern defibrillators.

Portable units become available

A major breakthrough was the introduction of portable defibrillators in ambulances. An ambulance is a Vehicle for transporting sick or injured people to from or between places of treatment for an Illness or Injury. This was pioneered in the early 1960s by Prof. Frank Pantridge in Belfast. James Francis "Frank" Pantridge MD, CBE (October 3 1916 Hillsborough County Down – December 26 2004 was a Physician and Belfast ( is the capital city of Northern Ireland and the seat of government in Northern Ireland. Today portable defibrillators are one of the most important tools carried by ambulances. They are the only proven way to resuscitate a person who has had a cardiac arrest unwitnessed by EMS who is still in persistent ventricular fibrillation or ventricular tachycardia at the arrival of pre-hospital providers.

Gradual improvements in the design of defibrillators, and partly based on the work developing implanted versions (see below) have lead to the availability of Automated External Defibrillators, which can analyse the heart rhythm by themselves, diagnosing the shockable rhythms, and then charging to treat. This means that no clinical skill is required in their use, allowing lay people to respond to emergencies effectively.

Change to a biphasic waveform

Until the late 1980s, external defibrillators delivered a Lown type waveform (see Bernard Lown) which was a heavily damped sinusoidal impulse having a mainly uniphasic characteristic. Bernard Lown, MD (born June 7, 1921) is the original developer of the Defibrillator and is an internationally known Peace activist Biphasic defibrillation, however, alternates the direction of the pulses, completing one cycle in approximately 10 milliseconds. Biphasic defibrillation was originally developed and used for implantable cardioverter-defibrillators. When applied to external defibrillators, biphasic defibrillation significantly decreases the energy level necessary for successful defibrillation. This, in turn, decreases risk of burns and myocardial damage.

Ventricular fibrillation (VF) could be returned to normal sinus rhythm in 60% of cardiac arrest patients treated with a single shock from a monophasic defibrillator. The normal electrical conduction in the heart allows the impulse that is generated by the Sinoatrial node (SA node of the Heart to be propagated to (and stimulate the Most biphasic defibrillators have a first shock success rate of greater than 90%. ^[3]

Implantable devices

A further development in defibrillation came with the invention of the implantable device, known as an implantable cardioverter-defibrillator (or ICD). An implantable cardioverter-defibrillator ( ICD) is a small battery -powered electrical impulse generator which is implanted in patients who are at risk of Sudden This was pioneered at Sinai Hospital in Baltimore by a team including Stephen Heilman, Alois Langer, Morton Mower, Michel Mirowski, and Mir Imran, with the help of industrial collaborator Intec Systems of Pittsburgh. Sinai Hospital is a Baltimore Maryland hospital originally founded in 1866 as the Hebrew Hospital and Asylum Dr Michel Mirowski ( October 14 1924 – March 26 1990) was born in Warsaw, Poland. Mir A Imran (born 1956 Hyderabad, India) is an Indian Entrepreneur and Venture capitalist. Mirowski teamed up with Mower and Staewen, and together they commenced their research in 1969 but it was 11 years before they treated their first patient. Similar developmental work was carried out by Schuder and colleagues at the University of Missouri. The University of Missouri (also known as the University of Missouri–Columbia, Mizzou, or MU) is a public land-grant and research

The work was commenced, despite doubts amongst leading experts in the field of arrhythmias and sudden death. There was doubt that their ideas would ever become a clinical reality. In 1972 Bernard Lown, the inventor of the external defibrillator, stated in the journal Circulation - "The very rare patient who has frequent bouts of ventricular fibrillation is best treated in a coronary care unit and is better served by an effective antiarrhythmic program or surgical correction of inadequate coronary blood flow or ventricular malfunction. Bernard Lown, MD (born June 7, 1921) is the original developer of the Defibrillator and is an internationally known Peace activist Circulation is a Scientific journal published by the American Heart Association. In fact, the implanted defibrillator system represents an imperfect solution in search of a plausible and practical application. "

The problems to be overcome were the design of a system which would allow detection of ventricular fibrillation or ventricular tachycardia. Despite the lack of financial backing and grants, they persisted and the first device was implanted in February 1980 at Johns Hopkins Hospital by Dr. Johns Hopkins University|Johns Hopkins University School of Medicine|Greenspring StationThe Johns Hopkins Hospital is a Teaching hospital in Baltimore Maryland Levi Watkins, Jr. Modern ICDs do not require a thoracotomy and possess pacing, cardioversion, and defibrillation capabilities. Thoracotomy is an incision into the Chest. It is performed by a surgeon and rarely by emergency physicians and Paramedics, to gain access to the thoracic organs

The invention of implantable units is invaluable to some regular sufferers of heart problems, although they are generally only given to those people who have already had a cardiac episode.

Types

Manual external defibrillator

External defibrillator / monitor

The units are used in conjunction with (or more often have inbuilt) electrocardiogram readers, which the clinician uses to diagnose a cardiac condition (most often fibrillation or tachycardia although there are some other rhythms which can be treated by different shocks). The clinician will then decide what charge (in joules) to use, based on their prior knowledge and experience, and will deliver the shock through paddles or pads on the patient's chest. As they require detailed medical knowledge, these units are generally only found in hospitals and on some ambulances. A hospital is an institution for Health care providing treatment by specialised staff and equipment and often but not always providing for An ambulance is a Vehicle for transporting sick or injured people to from or between places of treatment for an Illness or Injury. For instance, every NHS ambulance in the United Kingdom is equipped with a manual defibrillator for use by the attending paramedics and technicians. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located In the United States, paramedics are trained to recognize lethal arrhythmias and deliver appropriate electrical therapy with a manual defibrillator, when appropriate. The United States of America —commonly referred to as the A paramedic is a medical professional usually a member of the emergency medical service, who primarily provides Pre-hospital advanced medical and

Manual internal defibrillator

These are the direct descendants of the work of Beck and Lown. They are virtually identical to the external version, except that the charge is delivered through internal paddles in direct contact with the heart. These are almost exclusively found in operating theatres, where the chest is likely to be open, or can be opened quickly by a surgeon.

Automated external defibrillator (AED)

Main article: Automated external defibrillator

An AED at a railway station in Japan. For a topic outline on this subject see List of basic Japan topics. The AED box has information on how to use it in Japanese, English, Chinese and Korean, and station staff are trained to use it.

These simple to use units are based on computer technology which is designed to analyze the heart rhythm itself, and then advise whether a shock is required. They are designed to be used by lay persons, who require little training. They are usually limited in their interventions to delivering high joule shocks for VF and VT (ventricular tachycardia) rhythms, making them generally limiting for use by health professionals, who could diagnose and treat a wider range of problems with a manual or semi-automatic unit. A health care provider or health professional is an organization or person who delivers proper Health care in a systematic way professionally to any individual in

The automatic units also take time (generally 10-20 seconds) to diagnose the rhythm, where a professional could diagnose and treat the condition far quicker with a manual unit. These time intervals for analysis, which require stopping chest compressions, have been shown in a number of studies to have a significant negative effect on shock success. This effect led to the recent change in the AHA defibrillation guideline (calling for two minutes of CPR after each shock without analyzing the cardiac rhythm) and a statement in the ACLS Provider Manual that AEDs should not be used when manual defibrillators and trained operators are available.

Automated external defibrillators are generally either held by trained personnel who will attend incidents, or are public access units which can be found in places including corporate and government offices, shopping centres, airports, restaurants, casinos, hotels, sports stadiums, schools and universities, community centres, fitness centres and health clubs. For the government of parliamentary systems see Executive (government. An office is generally a room or other area in which people work, but may also denote a position within an Organization with specific duties attached A shopping mall or shopping centre is a building or set of buildings that contain Retail units with interconnecting Walkways enabling visitors An airport is a location where Aircraft such as airplanes, Helicopters and blimps take off and land A restaurant is a retail establishment that serves prepared Food to Customers. A casino is in the modern sense of the word a facility that houses and accommodates certain types of Gambling activities A hotel is an establishment that provides paid lodging usually on a short-term basis A modern stadium (plural stadiums or stadia in English is a place or venue for (mostly outdoor Sports Concerts or other events consisting A school (from Greek σχολεῖον - scholeion) is an Institution designed to allow and encourage Students (or "pupils" Higher education is Education that is provided by universities, vocational universities, Community colleges Liberal arts colleges

An automated external defibrillator, open and ready for pads to be attached

The locating of a public access AED should take in to account where large groups of people gather, and the risk category associated with these people, to ascertain whether the risk of a sudden cardiac arrest incident is high. For example, a centre for teenage children is a particularly low risk category (as children very rarely enter heart rhythms such as VF or VT, being generally young and fit, and the most common cause of paediatric cardiac arrest is trauma - where the heart is more likely to enter asystole or PEA, where an AED is of no use), whereas a large office building with a high ratio of males over 50 is a very high risk environment.

In many areas, emergency services vehicles are likely to carry AEDs, with some Ambulances carrying an AED in addition to a manual unit. In addition, some police or fire service vehicles carry an AED for first responder use. First responder is a term used to describe the first medically-trained responder to arrive on scene of an emergency accident natural or human-made disaster or similar event Some areas have dedicated community first responders, who are volunteers tasking with keeping an AED and taking it to any victims in their area. It is also increasingly common to find AEDs on transport such as commercial airlines and cruise ships.

In order to make them highly visible, public access AEDs often are brightly coloured, and are mounted in protective cases near the entrance of a building. When these protective cases are opened, and the defibrillator removed, some will sound a buzzer to alert nearby staff to their removal but do not necessarily summon emergency services. All trained AED operators should also know to phone for an ambulance when sending for or using an AED, as the patient will be unconscious, which always requires ambulance attendance.

Semi-automated external defibrillators

These units are a compromise between a full manual unit and an automated unit. They are mostly used by pre-hospital care professionals such as paramedics and emergency medical technicians. A paramedic is a medical professional usually a member of the emergency medical service, who primarily provides Pre-hospital advanced medical and The Emergency Medical Technician ( EMT) exists in many countries and is a health care provider trained to provide prehospital emergency medical care These units have the automated capabilities of the AED but also feature an ECG display, and a manual override, where the clinician can make their own decision, either before or instead of the computer. Some of these units are also able to act as a pacemaker if the heart rate is too slow (bradycardia) and perform other functions which require a skilled operator. For other uses see Pacemaker (disambiguation A pacemaker (or artificial pacemaker, so as not to be confused with the heart's natural pacemaker Bradycardia, as applied to adult medicine is defined as a resting Heart rate of under 60 beats per minute though it is seldom symptomatic until the rate drops below 50 beat/min

Implantable Cardioverter-defibrillator (ICD)

Main article: Implantable cardioverter-defibrillator

Also known as automatic internal cardiac defibrillator (AICD). An implantable cardioverter-defibrillator ( ICD) is a small battery -powered electrical impulse generator which is implanted in patients who are at risk of Sudden These devices are implants, similar to pacemakers (and many can also perform the pacemaking function). For other uses see Pacemaker (disambiguation A pacemaker (or artificial pacemaker, so as not to be confused with the heart's natural pacemaker They constantly monitor the patient's heart rhythm, and automatically administer shocks for various life threatening arrhythmias, according to the device's programming. Many modern devices can distinguish between ventricular fibrillation, ventricular tachycardia, and more benign arrhythmias like supraventricular tachycardia and atrial fibrillation. Ventricular fibrillation ( V-fib or VF) is a condition in which there is uncoordinated contraction of the Cardiac muscle of the ventricles in the Ventricular tachycardia ( V-tach or VT) is a Tachycardia, or fast heart rhythm that originates in one of the ventricles of the Heart A supraventricular tachycardia ( SVT) is a rapid rhythm of the Heart in which the origin of the electrical signal is either the atria or Atrial fibrillation ( AF or afib) is a Cardiac arrhythmia (abnormal heart rhythm that involves the two upper chambers ( atria) of the Heart Some devices may attempt overdrive pacing prior to synchronised cardioversion. When the life threatening arrhythmia is ventricular fibrillation, the device is programmed to proceed immediately to an unsynchronized shock.

There are cases where the patient's ICD may fire constantly or inappropriately This is considered a medical emergency, as it depletes the device's battery life, causes significant discomfort and anxiety to the patient, and in some cases may actually trigger life threatening arrhythmias. A medical emergency is an Injury or Illness that is acute and poses an immediate risk to a person's life or long term health Some emergency medical services personnel are now equipped with a ring magnet to place over the device, which effectively disables the shock function of the device while still allowing the pacemaker to function (if the device is so equipped). Emergency medical services (abbreviated to the initialism "EMS" in many countries are a branch of Emergency services dedicated to providing out-of-hospital A magnet (from Greek grc μαγνήτης λίθος " Magnesian stone" is a material or object that produces a Magnetic field. If the device is shocking frequently, but appropriately, EMS personnel may administer sedation.

Modeling Defibrillation

The efficacy of a cardiac defibrillator is highly dependent on the position of its electrodes. Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia. An electrode is an Electrical conductor used to make contact with a nonmetallic part of a circuit (e Most internal defibrillators are implanted in octogenarians, but a few children need the devices. Implanting defibrillators in kids is particularly difficult because children are small, will grow over time, and possess cardiac anatomy that differs from that of adults. Recently, researchers were able to create a software modeling system capable of mapping an individual’s thorax and determining the optimal position for an external or internal cardiac defibrillator. The thorax is a division of an Animal 's body that lies between the head and the Abdomen.

With the help of pre-existing surgical planning applications, the software uses myocardial voltage gradients to predict the likelihood of successful defibrillation. According to the critical mass hypothesis, defibrillation is effective only if it produces a threshold voltage gradient in a large fraction of the myocardial mass. Usually, a gradient of three to five volts per centimeter is needed in 95 % of the heart. Voltage gradients of over 60 V/cm can damage tissue. The modeling software seeks to obtain safe voltage gradients above the defibrillation threshold.

Early simulations using the software suggest that small changes in electrode positioning can have large effects on defibrillation, and despite engineering hurdles that remain, the modeling system promises to help guide the placement of implanted defibrillators in children and adults.

Interface with the patient

The most well-known type of electrode is the traditional metal paddle with an insulated handle. This type must be held in place on the patient's skin while a shock or a series of shocks is delivered. Before the paddle is used, a gel must be applied to the patient's skin, in order to ensure a good connection and to minimize electrical resistance, also called chest impedance (despite the DC discharge). Electrical resistance is a ratio of the degree to which an object opposes an Electric current through it measured in Ohms Its reciprocal quantity is These are generally only found on the manual external units.

Another type of resuscitation electrode is designed as an adhesive pad. When a patient has been admitted due to heart problems, and the physician or nurse has determined that he or she is at risk of arrhythmia, they may apply adhesive electrodes to the patient in anticipation of any problems that may arise. Dysrhythmia redirects here For the American band see Dysrhythmia (band. These electrodes are left connected to a defibrillator. If defibrillation is required, the machine is charged, and the shock is delivered, without any need to apply any gel or to retrieve and place any paddles. These adhesive pads are found on most automated and semi-automated units.

Both solid- and wet-gel adhesive electrodes are available. Solid-gel electrodes are more convenient, because there is no need to clean the patient's skin after removing the electrodes. However, the use of solid-gel electrodes presents a higher risk of burns during defibrillation, since wet-gel electrodes more evenly conduct electricity into the body.

Adhesive electrodes are designed to be used not only for defibrillation, but also for non-invasive pacing and electrical cardioversion. Synchronized electrical cardioversion is the process by which an abnormally fast Heart rate or Cardiac arrhythmia is terminated by the delivery of a therapeutic dose

While the paddles on a monitor/defibrillator may be quicker than using the patches, adhesive patches are superior due to their ability to provide appropriate EKG tracing without the artifact visible from human interference with the paddles. In Natural science and Signal processing, an artifact is any perceived Distortion or other Data error caused by the instrument of observation Adhesive electrodes are also inherently safer than the paddles for the operator of the defibrillator to use, as they minimize the risk of the operator coming into physical (and thus electrical) contact with the patient as the shock is delivered, by allowing the operator to stand several feet away. Another inconvenience of the paddles is the requirement of around 25lbs of pressure to be applied while defibrillating.

Placement

Anterio-apical placement of external defibrillator electrodes (When defibrillation is unsuccessful, anterio-posterior placement is also sometimes attempted)

Resuscitation electrodes are placed according to one of two schemes. The anterior-posterior scheme (conf. image) is the preferred scheme for long-term electrode placement. One electrode is placed over the left precordium (the lower part of the chest, in front of the heart). The other electrode is placed on the back, behind the heart in the region between the scapula. This placement is preferred because it is best for non-invasive pacing.

The anterior-apex scheme can be used when the anterior-posterior scheme is inconvenient or unnecessary. In this scheme, the anterior electrode is placed on the right, below the clavicle. The apex electrode is applied to the left side of the patient, just below and to the left of the pectoral muscle. This scheme works well for defibrillation and cardioversion, as well as for monitoring an ECG.

Popular culture references

In the television series Emergency!, firefighters often used defibrillators, with their 'catchphrase' being the standard warning (still used to this day) of yelling "Clear!" right before applying the shock, to warn everyone around to stay away from the patient for risk of electrical shock. Emergency! is a Medical drama Television series that was produced by Mark VII Limited ( Jack Webb 's company and distributed by

In the same series, the defibrillator induces a sudden, violent jerk or convulsion by the patient; in reality, although the muscles may contract, such dramatic patient presentation is rare. Most television shows will have the medical provider defibrillate the "flat-line" ECG rhythm (also known as asystole); this is not done in real life. In medicine asystole is a state of no cardiac electrical activity hence no contractions of the Myocardium and no cardiac output or blood flow Only the cardiac arrest rhythms ventricular fibrillation and pulseless ventricular tachycardia are normally defibrillated. Ventricular fibrillation ( V-fib or VF) is a condition in which there is uncoordinated contraction of the Cardiac muscle of the ventricles in the Ventricular tachycardia ( V-tach or VT) is a Tachycardia, or fast heart rhythm that originates in one of the ventricles of the Heart (There are also several heart rhythms that can be "defibrillated" when the patient is not in cardiac arrest, such as supraventricular tachycardia or ventricular tachycardia that produces a pulse, though the procedure is then known as cardioversion. A supraventricular tachycardia ( SVT) is a rapid rhythm of the Heart in which the origin of the electrical signal is either the atria or In Medicine, a person's pulse is the throbbing of their arteries. Synchronized electrical cardioversion is the process by which an abnormally fast Heart rate or Cardiac arrhythmia is terminated by the delivery of a therapeutic dose ) However, a 'flatline' may actually be a fibrillation that is too weak to be seen on the monitor (fine ventricular fibrillation), so a shock may be delivered, but it is not regarded as the treatment of choice, as the probability of a successful conversion is very small. According to the current guidelines, in this situation, continued CPR in order to improve the oxygenation of the heart for a few minutes is preferred before defibrillation is attempted.

In the NBC television series E.R. (1994-present) the defibrillator is used regularly. The National Broadcasting Company ( NBC) is an American Television network headquartered in the GE Building in New York City's ER is an Emmy Award -winning American Medical drama series created by Novelist Michael Crichton and airing on Year 1994 ( MCMXCIV) was a Common year starting on Saturday (link will display full 1994 Gregorian calendar) As the show is putting high value on medical realism the classical mistakes such as defibrillating a flat-line do not occur there.

In Australia up until the 1990s, it was quite rare for an ambulance to carry a defibrillator. For a topic outline on this subject see List of basic Australia topics. The 1990s collectively refers to the years between and including 1990 and 1999 This changed in 1990 when Australian media mogul Kerry Packer had a heart attack and the ambulance that responded to the call did carry a defibrillator. A media proprietor is a person who controls either through personal ownership or a dominant position in a Public company, a significant part of the Mass media. Kerry Francis Bullmore Packer, AC (17 December 1937 &ndash 26 December 2005 son of Sir Frank Packer, was an Australian publishing media and gaming tycoon After this, Kerry Packer donated a large sum to the Ambulance Service of New South Wales in order that all ambulances in New South Wales should be fitted with a personal defibrillator, leading to the Australian colloquial term for the device, Packer Whacker. The Ambulance Service of New South Wales (ASNSW is the main provider of pre-hospital emergency care and ambulance services in the state of New South Wales (NSW Australia A colloquialism is an expression not used in formal speech, writing or Paralinguistics. Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia.

See also

• Cardiopulmonary resuscitation (CPR)
• Advanced cardiac life support (ACLS)
• Cardioversion
• Implantable cardioverter-defibrillator
• Automated external defibrillator
• Heart Attack
• Ambulance

References

External links

• Center for Integration of Medicine and Innovative Technology
• American Red Cross: Saving a Life is as Easy as A-E-D
• FDA Heart Health Online: Automated External Defibrillator (AED)
• Resuscitation Council (UK)
• History of defibrillation
• How an internal defibrillator is implanted from Children's Hospital Heart Center, Seattle.