defibrillation

jeevan apakadappeduthunna cardiac arithmiyaykkulla chikilsayaanu defibrillation, prathyekichu ventricular fibrilation (vii-faib), noonn-perfusing ventricular tachycardia (vii-tatch) ennivaykkulla chikilsayaanu defibrillation. oru defibrillator hridayathilekku vaidyutha pravaahatthinte oru doses (palappozhum "kaundar-shock" ennu vilikkunnu) athikkunnu. poornnamaayum manassilaakkiyittillengil, eee prakriya hridaya peshikalude valia alavil depolarise cheyyukayum aritmiya avasanippikkukayum cheiyunnu. pinneedu, hridayathinte sinoatriyal nodile shareerathinte swaabhaavika pays makerinu saadhaarana sainas thaalam punasthaapikkaan kazhiyum. asistolil (flaatlain) ulla oru hridayam oru defibrillator upayogichu punaraarambhikkaan kazhiyilla, pakshe cardiopulmonary reseasitation (cpr) vazhi chikilsikkum.
defibrillation vipareethamaayi, synchronised electrical cardioversion ennathu hridayachakravumaayi samanvayippichu nalkunna oru vaidyutha shokkaan. vyakthi ippozhum gurutharaavasthayilaayirikkam, cardioversion saadhaaranayaayi supraventricular tachycardia polulla mosham hridaya aritmiya avasaanippikkaan lakshyamidunnu.
defibrilettarukal upayogichatho aavasyamullatho aaya upakaranathinte tharatthe aashrayich baahyamo transveenaso implaant cheythatho (implaantabil cardioverter-defibrillator) aakam. automated ekstenal defibrilettarukal (eiii. iii. dii. ezz) ennariyappedunna chila baahya unitukal chikilsikkaavunna thaalangalude roganirnayam automate cheiyunnu, athaayath saadhaarana prathikaranakkarkko kazhchakkaarkko cheriyatho pariseelanamo illaathe avaa vijayakaramaayi upayogikkaan kazhiyum.
defibrilettarukalude upayogam.
soochanakal.
cardiopulmonary reseasitation (sii. pii. aarr) yude oru pradhana gattamaanu defibrillation. hridaya, shwaasakosha pravartthanangal punasthaapikkaan lakshyamitulla algoritam adisthaanamaakkiyulla edapedalaanu cpr. chila tharatthilulla cardiac disrithmiyakalil, prathyekichu ventricular fibrilation (vf), pulsless ventricular tachycardia ennivayil maathrame defibrillation soochippikkappedunnul. asistol allengil pulsless electrical aaktivitti (pee) pole hridayam poornnamaayum nilachuvenkil, defibrillation soochippikkunnilla. rogikk bodhamundengilo pulse undengilo defibrillation soochippikkunnilla. anuchithamayi nalkia vaidyutha shokkukal ventricular fibrilation polulla apakadakaramaaya disrithmiyaykku kaaranamakum.
aaplikkeshan reethi.
medical sentarukalil ninnu saadhaaranayaayi labhyamaya defibrillation upakaranam automated ekstenal defibrillator (eiii. iii. dii) aanu, ithu munpariseelanamillaatha upayokthaakkalkk polum upayogikkaan kazhiyunna oru portable mesheenaan. upayokthaavine nayikkunna munkootty record cheytha shabda nirddeshangal yanthram nirmmikkukayum rogiyude avastha svayameva parisodhikkukayum sariyaaya vaidyutha shokkukal prayogikkukayum cheiyunnathinaal ithu saadhyamaan. nadapadikramam ghattam ghattamayi vishadeekarikkunna defibrilettarukalude rekhaamoolamulla nirddeshangalum nilavilundu.
phalangal.
aashupathrikk purathulla hridayasthambhanangalude athijeevana nirakk moshamaan, palappozhum 10 sathamaanathil thaazheyaan. ashupathriyil hridayasthambhanathinte phalam 20 sathamaanamaanu. hridayasthambhanam ullavarude koottatthinullil, nirddishta hridayamidippu athijeevana nirakkine ganyamaayi badhikkum. njettaatha thaalamulla (asistol allengil pee polullava) aalukalumayi thaarathamyappeduthumbol, njettikkunna thaalamulla aalukalkk (vf allengil pulsless ventricular tachycardia polullava) athijeevana nirakk mechappettittund, ithu 21 muthal 50 sathamaanam vare varum.
tharangal.
maanuval modalukal.
maanuval ekstenal defibrilettarukalkku oru aarogyaparipalana vidagthante vaidagdhyam aavasyamaanu. avaa oru electrocardiographuma samyojippichaan upayogikkunnathu, athu verittatho antharnirmmithamo aakam. oru aarogya parirakshaa daataav aadyam hridayathinte thaalam nirnnayikkukayum thudarnnu vaidyutha shokkinte voltage samayavum swamedhayaa nirnnayikkukayum cheiyunnu. eee unitukal pradhaanamaayum aashupathrikalilum chila aambulansukalilum kaanapedunnu. udaaharanathinu, yunaittad kingdatthile oro enhs ambulansilum pankedukkunna paramedicukaludeyum saankethika vidagtharudeyum upayogathinaayi oru maanuval defibrillator sajjeekarichirikkunnu. amerikkayil, marakamaaya aritmiya thirichariyunnathinum uchithamaaya samayat maanuval defibrillator upayogichu uchithamaaya electrical therapy nalkunnathinum niravadhi noothana eiii. emm. tukalum ellah paramedics pariseelanam nediyittundu. 
hridaya baipas polulla hridaya shasthrakriyaykkidayilo sheshamo hridayathe defibrilate cheyyaan oru aantharika defibrillator palappozhum upayogikkunnu. myokaardiyavumaayi nerittu sanbarkkam pulartthunna vrithaakrithiyilulla loha falakangal electrodukalil adangiyirikkunnu. maanuval intenal defibrilettarukal hridayathil nerittu sthaapichirikkunna paadilukaliloode shock nalkunnu. avaa kooduthalum operating roomilum apoorva saahacharyangalil, ooppan hart nadapadikramatthil emarjansi roomilum upayogikkunnu.
automated ekstenal defibrilettarukal.
automated ekstenal defibrilettarukal (eiii. iii. dii.) pariseelanam labhikkaathatho hrasvamaayi pariseelanam labhichatho aaya saadhaaranakkaarude upayogathinaayi roopakalppana cheythittullathaanu. hridayathinte thaalangal vishakalanam cheiyunnathinulla saankethikavidya eiii. iii. dukalil adangiyirikkunnu. thalphalamaayi, oru thaalam njettikkunnathaano allayo ennu nirnnayikkaan oru pariseelanam labhicha aarogya daataav aavasyamilla. eee unitukal pothuvaayi labhyamaakkunnathiloode, aashupathrikk purathulla pettennulla hridayasthambhanathinu eiii. iii. dii. ezz mechappetta phalangal nalkunnu.
pariseelanam labhicha aarogya professionalukalkku maanuval ekstenal defibrilettarukalekkaal aydukalkku parimithamaaya upayogamundu. ashupathriyil hridayasthambhanam ulla rogikalil aids phalam mechappeduthillennu sameepakaala padanangal kaanikkunnu. eiii. iii. dii. kku voltageukal sajjeekarichittund, aavasyathinanusarichu volteju maattaan oopparettare anuvadikkunnilla. phalapradamaaya cprinte vitharanam eiii. iii. dii. ezz vaikippichekkaam. thaalam kandethunnathinu, eds palappozhum nench compression nirthukayum shwasanathe rakshikkukayum venam. eee kaaranangalal, europian reseasitation kaunsil polulla chila samghadanakal, maanuval ekstenal defibrilettarukal eluppathil labhyamaanengil aydukalkku mukalil maanuval ekstenal defibrilettarukal upayogikkaan shupaarsha cheiyunnu.
aadyakaala defibrillation vf phalangal ganyamaayi mechappeduthaan kazhiyumennathinaal, eluppathil axus cheyyaavunna pala pradeshangalilum eiii. iii. dii. kall pothuvaayi labhyamaan. adisthaana life sapporttinaayi (bii. ell. ezz) eiii. iii. dii. kall algorithathil ulppeduthiyittundu. agnishamana senaamgangal, poleesukaar, suraksha gaardukal thudangi niravadhi aadya prathikaranakkar avare sajjaraakkiyittund.
eiii. iii. dii. kall poornnamaayum automatic allengil semi automatic aakam. oru semi automatic aid hridayathinte thaalangal svayameva kandethukayum oru shock aavashyamaano ennu nirnnayikkukayum cheiyunnu. oru shock nirddeshikkappettaal, shock niyantrikkaan upayokthaav oru button amarthanam. poornnamaayum automated aid hridayathinte thaalam svayameva nirnnayikkukayum shock svayameva nalkumbol pinnott nilkkaan upayokthaavine upadeshikkukayum cheiyunnu. maanuval override allengil isiji display polulla noothana savisheshathakalumaayaan chila tharam eds varunnath.
cardioverter-defibrilettarukal.
automatic intenal cardiac defibrillator (eiii. aii. sii. dii) ennum ariyappedunna implaantabil cardioverter-defibrilettarukal pays makerukalkku samanamaaya implaantukalaanu (palarkkum pays making pravartthanavum nadatthaan kazhiyum). avar rogiyude hridayamidippu nirantharam nireekshikkukayum upakaranathinte prograaming anusarichu, jeevan apakadappeduthunna vividha arithmiyaykk yaanthrikamaayi shokkukal nalkukayum cheiyunnu. ventricular fibrilation, ventricular tachycardia, supraventricular tachycardia, atrial fibrilation thudangiya kooduthal benign aritmiya enniva thammil verthirichariyaan pala aadhunika upakaranagalkkum kazhiyum. chila upakaranangal samanvayippicha cardioversion munbu overdrive pacing shramichekkaam. jeevan apakadappeduthunna aritmiya ventricular fibrilation aayirikkumbol, upakaranam udan thanne oru samanvayippikkaatha shokilekku neengaan prograam cheiyunnu.
rogiyude aii. sii. dii nirantharam allengil anuchithamayi vediyuthirkkunna kesukalundu. ithu oru medical emarjansiyaayi kanakkaakkappedunnu, kaaranam ithu upakaranathinte baattari life kuraykkunnu, rogikk kaaryamaaya aswasthathayum uthkandayum undaakkunnu, chila sandarbhangalil yadhaarthathil jeevan apakadappeduthunna arithmiyaykk kaaranamakum. chila emarjansi medical sarveesas udyogasthar ippol upakaranathinu mukalil sthaapikkaan oru ring maagnett sajjeekarichirikkunnu, ithu pacemakerine pravartthikkaan anuvadikkumbozhum (upakaranam athrayere sajjeekarichittundel) upakaranathinte shock function phalapradamaayi pravarthanarahithamaakkunnu. upakaranam idaykkide njettikkunnathaanenkilum uchithamaanengil, iii. emm. ezz udyogastharkku mayakka marunnu nalkaam.
apakadasaadyathayulla rogikalkku dharikkan kazhiyunna oru portable ekstenal defibrilettaraanu dharikkaavunna cardioverter defibrillator. yoonit 24 manikkoor rogiye nireekshikkukayum vf allengil vidi kandethiyaal yaanthrikamaayi oru biphasic shock nalkaan kazhiyukayum cheiyunnu. aii. sii. dii. kku udanadi sthaanaarthikalallaatha rogikalilaanu eee upakaranam pradhaanamaayum soochippikkunnathu.
interface.
defibrilettarum rogiyum thammilulla bandhatthil oru jodi electrodukal adangiyirikkunnu, oronnum oru nalla kanakshan urappakkunnathinum vaidyutha prathirodham kuraykkunnathinum vaidyutha chaalaka jell nalkunnu, ithu nench impedence (dissy discharge undaayirunnittum) ennum vilikkunnu, ithu rogiye kathikkum. jell onnukil nananjatho (sarjikkal lubricantinu samanamaaya) allengil kharamo (gammi candic samanamaaya) aakam. soolid-jell kooduthal soukaryapradamaanu, kaaranam defibrillationushesham vyakthiyude charmmatthil ninnu upayogicha jell vrithiyaakkendathilla. ennirunnaalum, soolid-jell upayogam defibrillation samayat pollalelkkaanulla saadhyatha kooduthalaanu, kaaranam eerppamulla-jell electrodukal shareerathilekku kooduthal thulyamaayi vaidyuthi vahikkunnu. aadyamaayi vikasippichedutha paddle electrodukal jell illaathe varunnu, koodaathe jell oru prathyeka ghattathil prayogikkanam. svayam-pasha electrodukal jell upayogichu sajjeekarichirikkunnu. ashupatri krameekaranangalil eathu tharatthilulla electrodaanu mikachathu ennathinekkurichu pothuvaaya abhipraaya vibhajanamund; american hart association anukoolamalla, aashupathrikalil upayogikkunna ellah aadhunika maanuval defibrilettarukalum svayam-pasha paadukalum parambaraagatha paadilukalum thammil vegathil marran anuvadikkunnu. oro tharatthilulla electrodinum athintethaaya gunangalum doshangalumundu.
paddle electrodukal.
insulated (saadhaaranayaayi plaastik) handle ulla parambaraagatha loha "haard" paadilaan ettavum ariyappedunna tharam electrode (sinimakalilum televisionilum vyaapakamaayi chithreekarichirikkunnu). oru shock allengil shokkukalude oru parambara nalkumbol ekadesham 25 poundu (11.3 kilogram) balam upayogichu rogiyude charmmatthil itharathilullava sthaapikkanam. svayam pasha paadukale apekshichu paddles chila gunangal vaagdaanam cheiyunnu. eee electrodukal sthaapikkaanum upayogikkaanum kazhiyunna antharleenamaaya vegatha kaaranam, mikka kesukalilum dispossible jell paadukal gadippichirikkunna paadilsinte upayogam yunaittad stetsile pala aashupathrikalum thudarunnu. hridayasthambhana samayat ithu nirnaayakamaan, kaaranam noonn perfusionte oro second tissue nashtam ennaanu ardhamaakkunnathu. aadhunika paddle nireekshanam (electrocardiography) anuvadikkunnu, ennirunnaalum ashupatri saahacharyangalil, prathyeka nireekshana leedukal palappozhum ithinakam thanne nilavilundu.
paddles veendum upayogikkaavunnavayaan, upayogathinu sesham vrithiyaakkukayum adutha rogikkaayi sookshikkukayum cheiyunnu. athinaal jell munkootty prayogichittilla, eee paddle rogiyude mail upayogikkunnathinu munbu ithu cherkkanam. saadhaaranayaayi maanuval baahya yoonittukalil maathrame paddle kaanapedukayulloo.
svayam-pasha electrodukal.
puthiya tharatthilulla punarujjeevana electrodukal oru pasha paadu aayi roopakalppana cheythirikkunnu, athil kharamo nananjatho aaya jell ulppedunnu. ivayude puram puramthallukayum aavasyamennu thonnumbol rogiyude nenjil prayogikkukayum cheiyunnu, mattethoru stikkarinum samaanamaan. paddles pole electrodukalum oru defibrilettarumaayi bandhippichirikkunnu. defibrillation aavashyamaanenkil, mesheen charge cheyyukayum shock vitharanam cheyyukayum cheiyunnu, adhika jell prayogikkukayo paddles veendedukkukayo sthaapikkukayo cheyyendathilla. mikka pasha electrodukalum defibrillation mathramalla, transcutaneous pacing, synchronised electrical cardioversion ennivaykkum upayogikkunna tharatthilaanu roopakalppana cheythirikkunnathu. eee pasha paadukal mikka automated, semi automated unitukalilum kaanapedunnu, koodaathe poornnamaayum ashupatri ithara krameekaranangalil paadilukal maattisthaapikkunnu. ashupathriyil, hridayasthambhanam undakaan saadhyathayulla (pakshe ithuvare undayittilla) kesukalil, svayam-pasha paadukal rogaprathirodhaparamaayi sthaapikkaam.
pariseelanam labhikkatha upayokthaavinum feeldinte ettavum anuyojyamallaatha avasthakalil jolie cheiyunna vaidyarkkum paadukal oru nettam vaagdaanam cheiyunnu. paadukalkk nireekshanatthinaayi adhika leedukal gadippikkendathilla, shock vitharanam cheiyunnathinaal avaykku oru balaprayogavum aavasyamilla. athinaal, oopparettare niravadhi adii akale nilkkaan anuvadikkunnathiloode shock nalkunnathinaal, pasha electrodukal oopparettar rogiyumaayi shaareerika (angane vaidyutha) sanbarkkathilekku varunnathinte apakadasaadhyatha kuraykkunnu. (oopparettarmaarude durupayogam moolamundaakunna shock pole mattullavarkk vaidyutha shock undakanulla saadhyathayum maattamillathe thudarunnu.) svayam-pasha electrodukal ottathavana maathram upayogikkunnavayaan. chikilsayude orotta kozhsil onniladhikam shokkukalkk avaa upayogichekkaam, pakshe rogi sukham praapikkukayaanenkil (allengil) veendum hridayasthambhanam undaayal avaa maattisthaapikkappedum.
8 vayassinu thaazheyulla kuttikalkko 55 poundil thazheyullavarkko prathyeka paadukal upayogikkunnu. (22 kilogram).
sthalam.
rund skeemukalilonninu anusarichaanu punarujjeevana electrodukal sthaapikkunnathu. deerghakaala electrode placementinulla munkaala-posteeriyar padhathiyaanu munkaala-posteeriyar padhathi. oru electrode idathu precordiathinu (nenchinte thaazhathe bhagam, hridayathinu munnil) mukalilaayi sthaapikkunnu. matte electrode purakil, skaapulaykkidayilulla pradeshathu hridayathinu pinnilaanu sthaapikkunnathu. noonn-invasive pacinginu ettavum anuyojyamaayathinaal eee placementaanu munganana nalkunnathu.
munkaala-posteeriyar skeem asoukaryamo anaavashyamo aayirikkumbol munkaala-apex skeem (munkaala-paarshwastha sthaanam) upayogikkaam. eee schemil, muun electrode valathuvashath, claviclinu thaazheyaan sthaapikkunnathu. rogiyude idathuvashathu, pectoral peshiyude thottadutthum idathuvashathum apex electrode prayogikkunnu. eee padhathi defibrillation cardioversion athupole thanne oru iii. sii. jii nireekshikkunnathinum nannayi pravartthikkunnu.
oru vyakthiyude nench mapp cheyyaanum baahyamo aantharikamo aaya cardiac defibrilatorinu ettavum mikacha sthaanam nirnnayikkaanum kazhivulla oru software modeling samvidaanam gaveshakar srishtichu.
samvidaanam.
defibrilationte krithyamaaya samvidaanam nannayi manassilakkiyitla. oru sidhaantham vijayakaramaya defibrillation hridayathinte bhooribhaagatheyum badhikkunnu, athinte falamaayi aritmiya thudaraan sheshikkunna hridaya peshikalude aparyaapthathayundaakunnu. sakthamaaya vaidyutha shokinode hridayakoshangal engane prathikarikkunnu ennathinekkurichu puthiya ulkkaazhcha nalkunnathaanu defibrilationte sameepakaala ganithashaasthra maathrkakal.
charithram.
1899ll swittsarlandile jineeva sarvakalaashaalayile rund physiologistukalaaya jeane-luis prevostum frederic batelliyum chernnaanu defibrilettarukal aadyamaayi pradharshippichathu. cheria vaidyutha shokkukal naaykkalil ventricular fibrilation undakkumennum valia chaarjukal eee avasthaye vipareethamaakkumennum avar kandethi.
1933ll doow. albert haiman, newyork sittiyile beth davis hospitalile hridaya vidagthan. hridayathilekku nerittu sakthamaaya marunnukal kuthivaykkunnathinu badal oru badal marunnu enchineeyaraaya henry haiman, marunnu kuthivayppinu pakaram electrical shock upayogicha oru kandupidutham konduvannu. eee kandupiduthathe "haiman oottar" ennu vilichirunnu, avide oru pollayaya soochi upayogichu oru insulated vayar hridayabhaagathekku kadathi vaidyutha shock nalkunnu. pollayaya urukk soochi sarkyoottinte oru attamaayum insulated vayarinte attam maruvashamaayum pravartthikkunnu. haiman oottar" vijayicho ennu anjjaathamaanu.
1930ll electrical enchineeyar vilyam kauvenhovan aanu innu ariyappedunna baahya defibrillator kandupidichathu. johns hoppins yooniversitti school oof enchineeyaringile vidyaarthiyaayirunnapol vaidyutha aaghaathangalum manushya hridayathil avaa cheluthunna swaadheenangalum thammilulla bandhathekkurichu kauvenhovan padichu. hridayathinte purambhaagathu ninnu chaadaan oru upakaranam kandupidikkaan addehathinte padanangal addehathe sahayichu. addeham defibrillator kandupidichu prevost, battelli polulla oru naayayil pareekshichu. 1947ll cases vestten reserve yooniversittiyile sarjari professoraaya claude bekkaanu manushyane aadyamaayi upayogichathu. adisthaanaparamaayi aarogyamulla hridayangalil, "marikkaan kazhiyaatha hridayangal" enna addehathinte vaakkukalil, ventricular fibrilation palappozhum sambhavikkunnu, avaye rakshikkaan oru maarggam undaayirikkanam ennathaanu bekkinte sidhaantham. janmana undaakunna valarchaa takaraar moolam vaariyellukalil ninnu nench asthikal verpeduthiya 14 vayassulla aankuttiyil beck aadyamaayi eee saankethikavidya vijayakaramaayi upayogichu, ithu shwasana prashnangalkk kaaranamaakunnu. aankuttiyude nench shasthrakriyayiloode thurakkukayum defibrillator athunnathuvare 45 minitt maanuval cardiac masaj nadathukayum cheythu. beck hridayathinte iruvashathum aantharika paddles upayogikkukayum antiarithamic marunnaaya prokkainamaidinoppam oru perfusing cardiac ridhathinte thirichuvaravu kaivarikkukayum cheythu.
eee aadyakaala defibrilettarukal oru power sokkattil ninnulla alternating karant upayogichu, lainil labhyamaya 110-240 voltil ninnu 300 muthal 1000 wolt vare "paddle" tharam electrodukal vazhi thuranna hridayathilekku parivartthanam cheythu. vf thirichukondupokunnathil eee saankethikavidya palappozhum phalapradamallaathappol morphological padanangal postmorttatthil hridaya peshikalude koshangalkk kedupaadukal varuthiyathayi kaanichu. valia transformerulla essy mesheente swabhaavavum eee unitukale kondupokaan valare budhimuttaakki, avaa chakrangalil valia unitukalaayi pravanatha kaanichu.
clossed-nench reethi.
reethi arambham vare, shasthrakriyaykkide nench arra thurannirikkumbol maathrame hridayathinte defibrillation saadhyamaayirunnullu. oro electrode ekadesham 40 millimeter vyaasamulla parannatho cheruthaayi konkevu loha plettullatho aaya "paddle" electrodukal vazhi thuranna hridayathinte vashangalilekku athikkunna staanderd essy pavaril ninnu uruthirinja 300 allengil athil kooduthal wolt srothassil ninnulla alternating volteju eee saankethikavidya upayogichu. nench koodiloode hridayathilekku baahyamaayi prayogikkunna electrodukal vazhi nadathunna 1000 voltil kooduthal alternating volteju prayogikkunna clossed-nench defibrillator upakaranathinu thudakkamittath doow. vii. esinte sahaayathode eskin. 1950 kalude madhyathil fransile klimov, yuu. ezz. ezz. aarr (innu kyrgyzstan, bishkek ennariyappedunnu). essy shokkukalude dairkhyam saadhaaranayaayi 100-150 millisekkandukalude paridhiyilaayirunnu.
nerittulla nilavile reethi.
mrugangalil nadatthiya kappaasittar discharge cheythukondu vijayakaramaya defibrilationte aadyakaala vijayakaramaya pareekshanangal enn report cheythu. ell. gurvichum jii. ezz. 1939-ll yunev. 1947-ll avarude kruthikal paashchaathya medical jenalukalil report cheyyappettu. gurvichinte pulse defibrilettarinte seeriyal uthppaadanam 1952 ll instittyoottile electromechanical plaantil aarambhichu, koodaathe model aidi-1-way ("impulesni defibrilettar 1, sesovsney electrotechnical instittyoott", allengil engleeshil, "pulse defibrillator 1, ool-union electrotechnical instittyoott") aayi namakaranam cheyyappettu. gurvichinte 1957 leeii "hart fibrilation aandu defibrillation" enna pusthakatthil ithu vishadamaayi vivarichittundu.
aadyathe checoslovac "yoonivezhsal defibrillator prema" 1957 ll doow. bohumil peleshka. 1958ll expo 58ll addehathinte upakaranathinu grand prix labhichu.
1958ll yuu. ezz. senattar hubert echu. humphry nikita krishchev sandarshikkukayum mattu karyangalkkoppam mosco instittyoott oof renematology sandarshikkukayum avide addeham gurvichumaayi koodikkaazhcha nadathukayum cheythu. punarnirmmaana gaveshanathinte praadhaanyam humphry udan thirichariyukayum athinusesham niravadhi american doctormar gurvich sandarshikkukayum cheythu. athe samayam, naashanal instittyoott oof healthil physiology aandu medisinil oru federal prograam sthaapikkunnathinu humphry pravarthichu, kongrasinodu paranju "namukk ningalumaayi malsarikkaam.ezz.ezz.aarr. maranatthinte thirichuvaravu sambandhicha gaveshanathil ".
1959-ll bernard loonn thante mrugangalude laboratariyil enchineeyar barau bercovitsumaayi sahakarichu oru saankethikavidyayilekku gaveshanam aarambhichu, athil kappaasittarukalude oru baank ekadesham 1000 voltilekku charge cheyyukayum athil 100-200 jools oorjjam ulppeduthukayum thudarnnu paddle electrodukal vazhi parimithamaaya dairkhyamulla (~ 5 millisecondukal) kanatha nananja sinusoidal tharamgam hridayathilekku ulppaadippikkunnathu polulla oru inductansiloode charge athikkukayum cheiyunnu. eee team cardiac sykkilile shock delivariyude opttimal samayathekkurichu kooduthal manassilakki, ithu "cardioversion" ennariyappedunna saankethikavidyayil atrial fibrilation, atrial flutter, supraventricular tachycardias thudangiya arithmiyakalil upakaranam prayogikkaan prapthamaakkunnu.
ariyappettirunnathupole, tharamgaroopam avasaanam vare defibrilationte maanadandamaayirunnu loonn-bercovits tharamgaroopam. tharamgaroopam thudakkathil, misauri sarvakalaashaalayile "myoo laab" biphasic tranketted tharamgaroopam (bii. tii. iii) enna puthiya tharamgaroopam avatharippikkunna niravadhi padanangalkku thudakkamittirunnu. eee tharamgaroopatthil, exponentialaayi shayikkunna dissy volteju, shock samayathinte pakuthiyolam dhruveeyathayil vipareethamaakunnu, thudarnnu kurachu samayathekku shayikkunnathu thudarukayum athinusesham volteju vichedikkappedukayo vettimaattappedukayo cheiyunnu. defibrillation uthppaadippikkunnathin kuranja alavilulla oorjjam nalkendivarunnappol biphasic katt cheytha tharamgaroopam kooduthal phalapradamaakumennu padanangal theliyichu. yanthrathinte bharam ganyamaayi kurachathu oru adhika nettamaayirunnu. traanstoraasik impedansinte automatic alaveduppumaayi samyojippicha bii. tii. iii tharamgaroopamaanu aadhunika defibrilettarukalude adisthaanam.
portable unitukal.
ashupathriyil ninnu portable defibrilettarukal avatharippikkunnathaayirunnu oru pradhana munnettam. ithinakam thanne pelescayude prema defibrillator yadhaartha gurvichinte modalinekkaal kooduthal portable aayi roopakalppana cheythittundu. soviyatt yooniyanil, gurvichinte defibrilettarinte portable pathippaya model dipa-3 (dpa-3) 1959 ll report cheyyappettu. padinjaaru ithu 1960 kalude thudakkathil propha. belfaasttil frank pantidge. innu ambulansukal vahikkunna niravadhi pradhana upakaranagalil onnaanu portable defibrilettarukal. pree-hospital daathaakkalude varavode sthiramaaya ventricular fibrilation allengil ventricular takkikardiyayil kazhiyunna emarjansi medical sarveesas (ems) saakshyam vahikkathe hridayasthambhanam sambhavicha oru vyakthiye punarujjeevippikkaanulla eaka theliyikkapetta maarggam avayaanu.
implaant cheytha pathippukal vikasippikkunna pravartthanatthe adisthaanamaakkiyulla defibrilettarukalude roopakalppanayile kramanugathamaaya mechappeduthalukal (chuvade kaanuka) automated ekstenal defibrilettarukalude labhyathayilekku nayichu. eee upakaranagalkk hridayathinte thaalam svayam vishakalanam cheyyaanum njettikkunna thaalam kandethaanum chikilsikkaan charge cheyyaanum kazhiyum. ithinartham avayude upayogathil klinikkal vaidagdhyam aavasyamilla, ithu saadhaaranakkaare adiyantharaavasthakalodu phalapradamaayi prathikarikkaan anuvadikkunnu.
tharamgaroopatthil maattam.
maattam pakuthi vare, baahya defibrilettarukal oru thaazhnna tharam tharamgaroopam nalki (bernard loonn kaanuka) ithu pradhaanamaayum unifasic swabhaavamulla kanatha nananja sinusoidal impulse aayirunnu. ekadesham 12 millisekkandukalkkull oru chakram poortthiyaakkunna biphasic defibrillation pulsukalude disha maattunnu. biphasic defibrillation yadhaarthathil vikasippikkukayum implaantabil cardioverter-defibrilettarukalkkaayi upayogikkukayum cheythu. baahya defibrilettarukalil prayogikkumbol, biphasic defibrillation vijayakaramaya defibrillation aavashyamaaya oorjja nila ganyamaayi kuraykkunnu, ithu pollalukaludeyum myocardial kedupaadukaludeyum saadhyatha kuraykkunnu.
monophasic defibrilettaril ninnulla orotta shock upayogichu chikilsikkappedunna 60 sathamaanam hridayasthambhana rogikalilum ventricular fibrilation (vf) saadhaarana sainas thaalatthilekku madangaan kazhiyum. mikka biphasic defibrilettarukalilum aadya shock vijaya nirakk 90 sathamaanathiladhikam aanu.
implaantabil upakaranangal.
implaantabil cardioverter-defibrillator (allengil icd) ennariyappedunna implaantabil upakaranathinte kandupiduthathodeyanu defibrilationil kooduthal vikasanam undaayath. baltimorile sinaay ashupathriyil steefan hailmann, alois langer, jacq lattukka, morttan mover, maikkal mirovsky, mirr imran ennivaradangiya oru samghamaanu pittsburgile vyaavasaayika sahakarana intech sisttangalude sahaayathode ithinu thudakkamittath. mirovsky mover, steevan ennivarumaayi chernnu 1969ll avar orumichu gaveshanam aarambhichu. ennirunnaalum, avarude aadya rogiye chikilsikkunnathinu 11 varsham munbaayirunnu athu. misauri sarvakalaashaalayile shooder sahapravarthakarum samanamaaya vikasana pravartthanangal nadatthi.
aritmiya, pettennulla maranam ennee mekhalakalile pramukha vidagtharkkidayil samshayangalkkidayilum pravartthanam aarambhichu. avarude ashayangal eppozhengilum oru klinikkal yaadhaarthyamaayi maarumo enna kaaryatthil samshayamundaayirunnu. 1962ll bernard loonn ekstenal dissy defibrillator avatharippichu. hridayathile fibrilation nirthaan eee upakaranam oru discharging kappaasittaril ninnu nench mathililoode hridayathilekku nerittu vaidyuthadhaara prayogichu. 1972-ll, loonn "sarkkuleshan" jenalil prasthaavichu-"ventricular fibrilation pathivayi undaakunna valare apoorva rogiye oru coronary cair yoonittil mikacha reethiyil chikilsikkukayum phalapradamaaya antiarithmic prograam allengil aparyapthamaaya coronary rakthayottam allengil ventricular takaraar ennivayude sasthrakriya thiruthal vazhi mikacha sevanam nalkukayum cheiyunnu. vaasthavathil, implaant cheytha defibrillator samvidaanam vishwasaneeyavum praayogikavumaaya prayogam thedunnathil apoornnamaaya parihaarathe prathinidheekarikkunnu."
ventricular fibrilation allengil ventricular tachycardia kandethaan anuvadikkunna oru samvidaanathinte roopakalppanayaayirunnu marikadakkenda prasnangal. saambathika pinthunayum graantukalum illengilum avaa nilanilkkukayum aadyathe upakaranam 1980 februvariyil johns hopkins ashupathriyil doow. levi vaatkins juuniyar. vivian thomasinte sahayavum. aadhunika aii. sii. deculk thorakottami aavasyamilla, koodaathe pacing, cardioversion, defibrillation kazhivukal ennivayundu.
pathiv hridaya prasnangalulla chila aalukalkk implaantabil yoonittukalude kandupidutham vilamathikkaanaavaathathaan, ennirunnaalum avaa saadhaaranayaayi ithinakam hridayasambandhamaaya prasnangal ullavarkku maathrame nalkoo.
upakaranangal upayogichu aalukalkk deerghakaalam saadhaarana jeevitam nayikkaan kazhiyum. pala rogikalkkum onniladhikam implaantukal undu. texasile hoosttanile oru rogi 1994 ll 18-aamm vayassil aduthide doow. antonio pasafico. 1996ll addehathinu "defibrillator upayogicha ettavum praayam kuranja rogi" enna bahumati labhichu. innu eee upakaranangal janichu taamasiyaathe cheria kunjungalil sthaapikkunnu.
samoohavum samskaaravum.
rogiyude aarogyathil naadakeeyamaaya mechappeduthalukal varuthaan kazhiyunna upakaranangal enna nilayil, defibrilettarukal palappozhum sinimakal, television, viidiyoo geyimukal, mattu saangalppika maadyamangal ennivayil chithreekarikkunnu. ennirunnaalum, rogiyude pettennulla, akramasakthamaaya virayalo virayalo undaakkunna defibrillator upayogichu avayude pravartthanam palappozhum athishayokthiparamaan. shock nalkumbol rogi pettennu valia uyarathilekku uyarunnathinoppam paadu placementum thettayi kaanikkunnu. vaasthavathil, peshikal churungiyekkaamenkilum, atharam naadakeeyamaaya rogiyude avatharanam apoorvamaanu. athupole, medical daathaakkale palappozhum "phlait-line" isiji rhythm (asistol ennum ariyappedunnu) ulla rogikale defibrilate cheiyunnathaayi chithreekarikkunnu. ithu saadhaarana vaidyashaasthramalla, kaaranam defibrilatorinu thanne hridayam punaraarambhikkaan kazhiyilla. hridayasthambhanathinte thaalangalaaya ventricular fibrilation pulsels ventricular tachycardia maathramaan saadhaaranayaayi defibrilate cheyyappedunnathu. muun asaadhaaranamaaya vaidyutha pravartthanatthinte abhaavathil hridayam swaabhaavikamaayi saadhaaranagathiyil midippu punaraarambikkumenna pratheekshayil, hridayathe muzhuvan oresamayam depolarise cheyyuka ennathaanu defibrilationte uddeshyam, angane athu samanvayippikkukayum thaalkkaalika asistoline phalapradamaayi prerippikkukayum cheiyunnu. ithinakam asistolil aaya oraale vaidyutha maargangaliloode sahayikkaan kazhiyilla, saadhaaranayaayi adiyanthira cpr intravinus marunnukalum aavasyamaanu (asistolinte kesukalil iva polum apoorvvamaayi vijayikkunnu). oormmikkenda oru upayogapradamaaya saamyam defibrilettarukale jump-starting ennathinekkaal power-saiklingaayi karuthuka ennathaanu. rogi hridayasthambhanathilallaathu "njettikkunna" niravadhi hridaya thaalangalundu, udaaharanathinu superraventricular tachycardia, ventricular tachycardia enniva pulse srishtikkunnu; kooduthal sankeernamaaya eee prakriya defibrillation allah, cardioversion ennu vilikkunnu.
vilikkunnu vare austreliyayil ambulansukal defibrilettarukal vahikkunnath thaarathamyena apoorvamaayirunnu. 1990ll australian maadyama mogul kerry packerinu hridayaaghaatham moolam hridayasthambhanam sambhavichathine thudarnnu ithu maari, koodaathe aakasmikamaayi, kolinode prathikaricha ambulancil oru defibrillator undaayirunnu. sukham praapichathinushesham, nyoo southu veyilsile ellah aambulansukalilum oru pezhsanal defibrillator gadippikkunnathinaayi kerry packer nyoo southu veylsinte ambulance sevanathinu oru valia thuka sambhavana cheythu, athinaalaan australiyayile defibrilettarukale chilappol "packer vaakkezhs" ennu vilikkunnathu.

