I also have not encountered the theory about chest compression controlling fibrillation. Since defibrillation is also controlled during open heart surgery by paddles directly applied to the heart and through the use of wire catheters from implantable defibrillators, it is not the only means. I thought it might be interesting to describe the heart function in electrical terms since that is the basis of understanding for most of us in this group. Heart muscle can be viewed as a simple free running flip-flop oscillator. When cut into pieces, each piece of heart muscle will automatically fire (contract) at its own natural rate. It can be triggered earlier by input from neighboring tissue. Once it fires, it goes through a relaxation stage when it is quite resistant to triggering by neighboring tissue. This firing at a cellular level is call depolarization. It is caused by the cell wall suddenly becoming permeable to sodium and potassium ions and loosing its charge (which of course is a current flow). The cell then takes time to recharge by pumping ions back across the cell wall. The master clock for the heart is the sinoatrial (SA) node (the sinus node mentioned by Gary). This node sets the pace for the heart in response to assorted hormone and brain inputs. It is located in the right atrium. Remember the heart has four chambers. The right atrium is a collecting spot for the returning blood and when it contracts, moves the blood next door to the right ventricle. The right ventricle pumps into the lungs. The left atrium holds returning oxygenated blood and pushes it into the left ventricle which pumps into the rest of the body. Obviously the ventricles are the workhorses. When the sinoatrial node fires, a wave of depolarization spreads over both atria (1/10 of a second), but is protected from reaching the ventricles by a layer of insulation. At the base of the right atrium it reaches the atrioventricular (AV) node. This is a delay line (another 1/10 of a second) and passes the signal to the left and right bundle branches which are special conductors to get the signal quickly to all parts of the ventricles. The AV delay provides the time for the atria to finish filling the ventricles before the much more significant contraction of the ventricles. Since all these conductors are live tissues, injury or irritation, depending on where it occurs, can cause all sorts of problems like fast or slow rhythms, lack of coordination of atria and ventricles, etc. One solution is implantable pacemakers which in their simplest forms electrically trigger the ventricles (the atria are left to themselves since they are not as important). Fibrillation occurs when something (like electric shock or irritation) triggers a piece of heart muscle. This in turn triggers neighboring cells. Unfortunately when the coordinated signal arrives from elsewhere, the cells which have just fired can't respond since they have not gone through their refractory period. These misfired cells then wait (while other parts are recovering) and having waited too long, fire on their own again. When several locations of the heart are doing this, the heart just quivers instead of making a coordinated pumping effort. The fix is to provide an electrical jolt which doesn't bother with triggering, it just hits all the cells with enough energy to force depolarization anyway. Then all cells together go through their refractory period and are ready for a coordinated trigger (if it still exists). This is why very high shock levels can avoid causing fibrillation. Defibrillators have come a long way from the old days when they just applied a severe 60 cycle AC shock. These days they try to provide a minimal level impulse coordinated with any residual heart beat to force the heart into unified action. The impulse can be applied with external paddles, and now is available as a built in part of implanted pacemakers so the impulse can be applied directly to the heart using the pacing electrodes. Bob Johnson -----Original Message----- From: owner-emc-p...@majordomo.ieee.org [mailto:owner-emc-p...@majordomo.ieee.org] On Behalf Of Bill Owsley Sent: Monday, November 19, 2001 1:22 PM To: Gary McInturff; 'Gregg Kervill'; 'Rich Nute' Cc: jrbar...@lexmark.com; emc-p...@majordomo.ieee.org Subject: RE: Define Continuous DC Voltage I've never seen cardiac function or resuscitation explained this way... and I'm an EMT-D. The D is for defibrillator and the EMT is for emergency medical technician. And with very few exceptions, the rest of the medical aspects of this discussion have been suspect. As my kids say - don't go there...
- Bill At 12:02 PM 11/19/2001 , Gary McInturff wrote: From a few courses several years back. The heart has something called the Sinus node (spelling could be wrong) The responsibility of that node is to control the timing of the electric wave "front" if you will. The heart actually has about three pulses. Looking at a heart waveform on a monitor you will see a small blip, big blip, and another smaller blip (those all being medical terms naturally). Those are the QRS waves, and sweep across the heart, from the input side to the output, although the "big blip' is the main blood moving event. I no longer remember exactly what each of the pulses does, but all three are needed for the pumping of blood through the heart chambers, and the sinus node does all the time for these events. When "low" level current disrupts this timing sequence the heart starts to fibrillate - it beats unrhymtically and "quivers" not only does it not pump blood but it works itself into exhaustion. The node needs to be allowed to resynchronize. That is done with a "high" current applied to a defibrillator paddle from one side of the chest to the other. When this is done it is not the current through the heart that is effective but the current through the muscles of the chest that are effective. The current causes the muscles to constrict hard enough to squeeze the heart muscle and prevent it from the uncontrolled and uncoordinated pulsing. The current is release, the muscles relax, and it is hoped that the sinus node re-takes control of the heart. This is the reason that the old method of reviving someone by slamming them in the chest worked. It forced the heart to stop long enough for the sinus node to reestablish itself. People that work around high voltage are more prone to death by falling from the high voltage lines, or internal burns that actual heart failure do to heart fibrillation. Gary -----Original Message----- From: Gregg Kervill [mailto:gkerv...@eu-link.com] Sent: Tuesday, November 13, 2001 1:12 PM To: 'Rich Nute' Cc: jrbar...@lexmark.com; emc-p...@majordomo.ieee.org Subject: RE: Define Continuous DC Voltage Hi Rich > There was also a very good (but short) article by Tektronix in the 70's > called The Lethal Current. > > It concluded that currents between 100 mA and 3 Amps were more lethal that > currents of more than 3 Amps because those high currents tended to 'restart' > the heart. Hmm. Having been the manager of product safety at Tektronix in the '70's, I don't recall such an article. At least not by that name. - I'll try and find it - it may have called the fatal current circa 72-5 published in the UK B-I-G SNIP INFORMATION OVERLOAD!!!!!! I'm squeamish So, Gregg's statement that there is both a lower and upper limit for fibrillation is correct (although I do not agree with Gregg's values). Hang on - I'm trying to quote from an article I read in the early 70's - and the figures were from the article. I'm sure it was from Tex - we had a number of the big valve 'scopes (plugins and more than 100 valves) - wonderful things and the only ones that allowed a delay longer than the TB sweep. I'll try to dig the article out - I found it very useful - particularly since the safety standards at that time were pretty Spartan. Thank goodness they have - and continue to help and provide guidance. Best regards Gregg ------------------------------------------- This message is from the IEEE EMC Society Product Safety Technical Committee emc-pstc discussion list. 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Visit our web site at: http://www.ewh.ieee.org/soc/emcs/pstc/ To cancel your subscription, send mail to: majord...@ieee.org with the single line: unsubscribe emc-pstc For help, send mail to the list administrators: Michael Garretson: pstc_ad...@garretson.org Dave Heald davehe...@mediaone.net For policy questions, send mail to: Richard Nute: ri...@ieee.org Jim Bacher: j.bac...@ieee.org All emc-pstc postings are archived and searchable on the web at: No longer online until our new server is brought online and the old messages are imported into the new server. ----------------------------- British Prime Minister Tony Blair pointed to the victims of the Sept. 11 attacks on the World Trade Center and the Pentagon, and said the Taliban regime had no "moral inhibition" on slaughtering innocent people. "There is no compromise possible with such people, no meeting of minds, no point of understanding with such terror," he said. "There is just a choice: Defeat it or be defeated by it and defeat it we must." "Whatever the dangers of the action we take, the dangers of inaction are far, far greater," he said. ---------------------------- Bill Owsley, ows...@cisco.com 919) 392-8341 Compliance Engineer Cisco Systems 7025 Kit Creek Road POB 14987 RTP. NC. 27709 ------------------------------------------- This message is from the IEEE EMC Society Product Safety Technical Committee emc-pstc discussion list. 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