PHYSICS

Transition from laminar to turbulent flow

Physical Principles of
Defibrillators
David J Williams
Fiona J McGill
Hywel M Jones
Defibrillation is the application of a preset electrical current
across the myocardium to cause synchronous depolarization of
the cardiac muscle with the aim of converting a dysrhythmia
into normal sinus rhythm. Over 135,000 people die annually
following acute myocardial infarction. The main cause of sudden
death is ventricular fibrillation; the only effective treatment for
which is early defibrillation. The defibrillator was invented in
1932 by Dr William Bennett Kouwenhoven.

Principle of Venturi

Capacitors
The most important component of a defibrillator is a capacitor
that stores a large amount of energy in the form of electrical
charge, then releases it over a short period of time. A capacitor
consists of a pair of conductors (e.g. metal plates) separated by
an insulator (called a dielectric). Conductors lose and gain
electrons easily, and therefore allow current to flow; whereas
insulators do not lose their electrons, and hardly allow any
current to flow. The maximum working voltage is the voltage
that when exceeded causes the dielectric to break down and
conduct, often with catastrophic results.
The unit of electric charge (Q) is the coulomb (C). 1 coulomb
is the quantity of electricity transported in 1 s by a current of 1
ampere (A) and is equivalent to 6.24 x 1018 electrons (Figure 1).
Capacitance (C) is the ability to store charge. A capacitor has
1 farad of capacitance if a potential difference of 1 volt is
present across its plates, when a charge of 1 coulomb is held by
them (i.e. C = Q/V). Capacitors typically have values of microfarads (F = 106 F), nanofarads (nF = 109 F) or picofarads
(pF = 1012 F). For a simple capacitor, the capacitance is proportional to the area over which the plates overlap (A), inversely
proportional to their distance apart (D), and related to the dielectric constant (Eo). Thus C A/D. Eo

of the tube; is viscosity. The effect of density (mass/volume)

on flow is evident in the use of helium and oxygen to promote
flow in patients with upper airway obstruction. The density of
air is 1.29, of oxygen 1.43 and helium 0.18 at STP.
The Bernoulli equation states that for an incompressible,
non-viscous fluid undergoing steady flow, the pressure plus the
kinetic energy per unit volume plus the potential energy per unit
volume is constant at all points on a streamline:
P + 12v2 + gh = Constant
where: P is the pressure within the fluid; v is the velocity of the
fluid; is the density of the fluid; g is acceleration due to gravity;
h is the height of the fluid above some arbitrary reference line.
It follows from Bernoullis equation that whenever a flowing fluid
speeds up, there is a corresponding decrease in the pressure
and/or the potential energy of the fluid and an increase in kinetic
energy. If the flow is horizontal the whole of the velocity increase
is accounted for by a decrease in pressure as the total energy
must remain constant. A Venturi tube has a constriction in which
the bore gradually decreases and then increases (Figure 8). At
the narrowest point the pressure drops as the flow of a fluid
through the constriction increases. In medicine, applications
include oxygen masks and nebulizers. Everyday applications
include an aerofoil, spinning ball, filter pumps, Bunsen burners
and carburettors.
u

ANAESTHESIA AND INTENSIVE CARE MEDICINE

David J Williams is Clinical Fellow in Cardiothoracic Anaesthesia at

the Royal Brompton Hospital, London. He graduated from Birmingham
University Medical School and completed his CCST in anaesthesia in
South Wales. He spent 18 months in Adelaide doing research in diving
and hyperbaric medicine.
Fiona J McGill is Specialist Registrar in Anaesthesia at the Royal
Gwent Hospital, Newport, Wales. She graduated from the University of
Wales College of Medicine, Cardiff.
Hywel M Jones is Associate Medical Director (Teaching) and
Sub Dean of Medicine, Gwent Clinical School, University of Wales
College of Medicine. He is a Primary FRCA Examiner for the Royal
College of Anaesthetists. He graduated from the University of Wales
College of Medicine, Cardiff.

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2003 The Medicine Publishing Company Ltd

PHYSICS

Work must be done against the field to store charge in the

capacitor. The charged capacitor is therefore a store of potential
energy, which may be released on discharge. Theoretically, the
amount of energy stored in a capacitor is CV.
When the paddles are applied to the patients chest and the
switch is moved to position 2, a circuit is completed. Electrons
stored on the lower (negative) plate of the capacitor are able to
pass through the patient and back to the upper plate. Thus, current flows, stored electrical energy is released, and the potential
difference across the plates (V) falls to zero (i.e. the capacitor is
discharged). The rate of discharge declines as the potential
difference across the plates falls; it is an exponential process
(Figure 4) with a time constant determined by the capacitance
and the resistance of the circuit through which the current flows.
The energy delivered may be calculated from: Energy (J) = 12
x stored charge (Q) x Potential (V) (i.e. Energy = QV/2). Thus,
400 J = 12 x 160 mC x 5000 V. The apparent loss of half of the
stored charge on discharge is due to circuit resistance, radiation
and arcing of switch contacts.

Key formulae and definitions

Current is charge per second
Power is energy (or work) per second
Power is current x potential difference

A = Q/s
W = J/s
W = AV

Stored charge
Stored energy
Delivered energy

Q = CV
J = CV
J = QV/2

C, capacitance in farads; Q, charge in coulombs; V, potential difference

in volts; J, energy (or work) in joules; W, power in watts; A, current in
amperes

Figure 2 shows a defibrillator. When the switch is in

position 1, direct current (DC) from the power supply is applied
to the capacitor. Electrons flow from the upper plate to the
positive terminal of the power supply and from the negative
terminal of the power supply to the lower plate. Therefore current
flows and a charge begins to build up on each electrode of the
capacitor, with the lower plate becoming increasingly negatively
charged, and the upper plate increasingly positively charged. As
the charge builds up on the plates, it creates a potential difference
across the plates (V), which opposes the electromagnetic force
of the power supply (E). Initially when there is no charge on the
plates, V is zero and it is easy to move electrons onto the plates.
As V increases, however, it opposes further movement of electrons, and increasing work must be done to move more electrons
onto the plates. The work done (W) to move charge (Q) through
a potential difference V is: W = VQ. Charging a capacitor is
therefore an exponential process, with a time constant
determined by the capacitance and the resistance of the
circuit through which the current flows (Figure 3). When V
equals E, the current ceases to flow and the capacitor is fully
charged. In this example, the amount of charge stored (Q = CV)
is 32 F x 5000 V = 160 mC.

Inductors
For successful defibrillation, the current delivered must be
maintained for several milliseconds. However, the current and
charge delivered by a discharging capacitor decay rapidly and
exponentially. Inductors are therefore used to prolong the
duration of current flow. They are coils of wire that produce a
magnetic field when current flows through them. When current
passes through an inductor, it generates a flow of electricity in
the opposite direction which opposes current flow as predicted
by Faradays law of electromagnetic induction. This opposition
to current flow is called inductance (L) and is measured in
henries (H). Inductors typically have values of microhenries (H).
Power supply
Step-up transformers are used to convert the mains voltage of
240 V AC to 5000 V AC. This is then converted to 5000 V DC by

Mechanism of action of a defibrillator

Inductor
Switch
1
2

++ ++

Patient impedance 50150

Paddle

Capacitor
32 F

0.63E

V = E (1-et/RC)

RC

Paddle

RC is the time constant, and is the time taken for the potential
difference across the plates (V) to reach 63% (1l/e) of the value
of the electromotive force of the power source (E)

Power supply 5000 V

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ANAESTHESIA AND INTENSIVE CARE MEDICINE

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2003 The Medicine Publishing Company Ltd

PHYSICS

International Electrotechnical Committee (IEC)

symbols for defibrillator safe equipment

The two symbols outside each square indicate that equipment is

protected from damage if the patient to whom it is connected
receives cardiac defibrillation

a Equipment meeting IEC

type BF leakage current
requirements

b Equipment meeting IEC

type CF leakage current
requirements

a rectifier. In practice, a variable voltage step-up transformer is

used so that different amounts of charge may be selected by the
clinician. The control switch is calibrated in energy delivered to
the patient (J), because this determines the clinical effect. If a
mains supply is unavailable, most defibrillators have internal
rechargeable batteries. These supply DC, which is then converted
to AC by means of an inverter, and then amplified to 5000 V DC
by a step-up transformer and rectifier as above.

prevent burns but small enough to deliver an adequate current

density.
Conductive gel pads and firm pressure (about 10 kg force) are
used to improve electrical contact between the paddles and the
patients chest. Liquid electrode gel should not be used, because
excess may cause arcing across the surface of the chest wall or
the operators hands.
All sources of oxygen must be removed from the patient during
defibrillation, because it supports combustion if arcing occurs.

Patient factors
Successful defibrillation depends on delivery of the electrical
charge to the myocardium. Only part of the total current delivered
(about 35 A) flows through the heart. The rest is dissipated
through the resistance of the skin and the rest of the body. The
impedance of skin and thoracic wall act as resistances in series,
and the impedance of other intrathoracic structures act as
resistances in parallel with the myocardium. The total impedance
is about 50150 , however, repeated administration of shocks
in quick succession reduces impedance.

Staff should not touch the bed, patient or any equipment

connected to the patient during defibrillation. Fluids may
conduct electricity, therefore it is important to ensure that the
immediate area is clean and dry. The defibrillator should not be
charged until the paddles are applied to the patients chest,
because accidental discharge from open paddles may cause injury
or death. The operator must not touch any part of the paddle
electrodes. Before administering the charge, the operator must
shout Stand clear! and check that all staff have done so.
If the defibrillator is charged but a shock is no longer indicated,
it should be discharged through the defibrillator internally by
turning the control knob to zero before removing the paddles
from the patients chest: charged paddles should never be
returned to the defibrillator.

Safety
Patient: before administering the charge, it is essential to make
the correct diagnosis to avoid defibrillating a patient who is
already in sinus rhythm. If a defibrillator monitor is being
used, check that the leads are correctly connected, and whether
the device is monitoring from the paddles or from chest
electrodes.
The paddles should be placed across the long axis of the heart
to facilitate effective defibrillation. The paddles should not be
placed over transdermal patches, because they may block current
delivery or if they contain an inflammable substance (e.g. glyceryl
trinitrate) may result in burns or explosion. The paddles should
not be placed near metal objects, either on the surface of the skin
(e.g. ECG leads or electrodes, skin clips, jewellery), or subcutaneously (e.g. implanted pacemakers), because the current follows
the path of least resistance through the metal, resulting in arcing,
heating or burns. The paddle size should be appropriate for the
patient (typically 13 cm diameter for adults): large enough to

ANAESTHESIA AND INTENSIVE CARE MEDICINE

Equipment that does not have the defibrillator protected symbol

(Figure 5) should be disconnected from the patient before defibrillation to prevent damage, heating or arcing effects. The defibrillator should never be discharged with the paddles shorted
together, as this may cause burning and damage to the electrical
contacts.
u
FURTHER READING
Mushin W M, Jones P L. Physics for the Anaesthetist. 4th ed. London:
Blackwell, 1987.
Parbrook G D, Davis P D, Parbrook E O. Basic Physics and
Measurement in Anaesthesia. 3rd ed. London: ButterworthHeinemann, 1993.

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2003 The Medicine Publishing Company Ltd