8 - 2
• Impedance is the resistance between the electrode pads/external paddles that the defibrillator must
overcome to deliver an effective discharge of energy. The degree of impedance differs from patient
to patient and is affected by several factors including the presence of chest hair, moisture, and
lotions or powders on the skin. If the “Impedance Too High, Shock Not Delivered” message appears,
make sure that the patient’s skin has been dried and that any chest hair has been clipped. If the
message persists, change the electrode pads and/or the pads cable.
• Alarms are switched off automatically and the “Alarm Off” message is displayed when the
equipment enters the asynchronous defibrillation mode. Alarms remain off until toggled on by
pressing the Alarm Pause button, the Sync mode, the Monitor mode or Pacer mode is entered.
• Successful resuscitation is dependent on many variables specific to the patient’s physiological state
and the circumstances surrounding the patient event. Failure to have a successful patient outcome is
not a reliable indicator of equipment performance. The presence or absence of a muscular response
to the transfer of energy during electrical therapy is not a reliable indicator of energy delivery or
equipment performance.
8.2 Manual Defibrillation Procedure
• Hold only the insulating parts of the paddle handles to avoid shock hazard during charging or shock
delivery.
• Anterior - lateral placement for adult patients, and anterior-posterior placement for pediatric
patients are recommended placements for defibrillation with electrode pads.
• Anterior - lateral placement is the only placement for defibrillation with external paddles.
• Defibrillation is always performed through external paddles or electrode pads. However, during
defibrillation you may choose to monitor the ECG using an alternate ECG source (3- or 5-lead
monitoring electrodes). If an alternate ECG source is connected, any available lead may be
displayed.
• When external paddles are used, the Shock button on the front panel is disabled.
• For defibrillation of pediatric patients, you can use the default energy level, or adjust the energy
level to 2-4 J/kg for the first shock and 4 J/kg for additional shocks followed the first shock.
• For defibrillation of pediatric patients under 8 years, pediatric electrode pads should be used.
• If pediatric electrode pads are not available, the adult electrode pads may be used instead, and set
the patient category to [Ped].
• For defibrillation of neonatal patients, set the energy level according to the patient’s clinical
condition. The energy level for neonatal patient should be lower than the default setting.
8.2.1 Using Internal Paddles
• When internal paddles are used for defibrillation, the energy selection is automatically limited to 50
joules because of possible cardiac damage from higher energies.
• Sterilize the internal paddles before each use. Otherwise, severe infection may result.
• Clean the internal paddles after each use.
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