- Bls For Healthcare Providers Student Manual Free Download For Mac
- Bls For Healthcare Providers Student Manual Free Download For Windows 10
Free local pickup. Or Best Offer. 5 new & refurbished from $13.00. 18 product ratings - BLS for Healthcare Providers - Professional Student Manual - 978-0-87493-461-8. NEW BLS For Healthcare Providers Student Manual: Basic Life Support Handbook See more like this. General Concepts. BLS Course Objectives. Provider Manual. Age Definitions. Review Questions. Student Notes. High-Quality CPR. Feb 19, 2019 - The OOH can help you find career information on duties, education and training, pay, and outlook for hundreds of occupations. Free CPR Study Guide. CPR, AED, First Aid, ACLS, PALS, BBP, BLS and NRP. And pdf study guides / student manuals to help prepare for your CPR / AED / First Aid and BLS for Healthcare Providers (Basic Life Support) course. Study Guide Download Study Guide Practice Exam Register Now. Bloodbone Pathogens Certification. Accredited Basic Life Support (BLS) Course. It is intended to summarize important content, but since all BLS content cannot possibly be absorbed in a class given every two years, it is expected that the student will have the 2010 Updated ECC Handbook readily available for review as a reference.
The OOH can help you find career information on duties, education and training, pay, and outlook for hundreds of occupations.
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Bls For Healthcare Providers Student Manual Free Download For Mac
Funeral Service Workers
Funeral service workers organize and manage the details of a funeral.
view profile »Insurance Underwriters
Insurance underwriters decide whether to provide insurance, and under what terms. They evaluate insurance applications and determine coverage amounts and premiums.
view profile »Computer and Information Research Scientists
Computer and information research scientists invent and design new approaches to computing technology and find innovative uses for existing technology. They study and solve complex problems in computing for business, medicine, science, and other fields.
view profile »Mathematicians and Statisticians
Mathematicians and statisticians analyze data and apply mathematical and statistical techniques to help solve real-world problems in business, engineering, healthcare, or other fields.
view profile »Atmospheric Scientists, Including Meteorologists
Atmospheric scientists study the weather and climate, and examine how those conditions affect human activity and the earth in general.
view profile »Economists
Economists study the production and distribution of resources, goods, and services by collecting and analyzing data, researching trends, and evaluating economic issues.
view profile »Health Educators and Community Health Workers
Health educators teach people about behaviors that promote wellness. They develop and implement strategies to improve the health of individuals and communities. Community health workers collect data and discuss health concerns with members of specific populations or communities..
view profile »Court Reporters
Court reporters create word-for-word transcriptions at trials, depositions, and other legal proceedings. Some court reporters provide captioning for television and real-time translation for deaf or hard-of-hearing people at public events, in business meetings, or in classrooms.
view profile »Dietitians and Nutritionists
Dietitians and nutritionists are experts in the use of food and nutrition to promote health and manage disease. They advise people on what to eat in order to lead a healthy lifestyle or achieve a specific health-related goal.
view profile »Audiologists
Audiologists diagnose, manage, and treat a patient’s hearing, balance, or ear problems.
view profile »Travel Agents
Travel agents sell transportation, lodging, and entertainment activities to individuals and groups planning trips. They offer advice on destinations, plan trip itineraries, and make travel arrangements for clients.
view profile »Electricians
Electricians install, maintain, and repair electrical power, communications, lighting, and control systems in homes, businesses, and factories.
view profile »Advertising, Promotions, and Marketing Managers
Advertising, promotions, and marketing managers plan programs to generate interest in products or services. They work with art directors, sales agents, and financial staff members.
view profile »Sales Managers
Sales managers direct sales teams. They set sales goals, analyze data, and develop training programs for organizations’ sales representatives.
view profile »Administrative Services Managers
Administrative services managers plan, direct, and coordinate supportive services of an organization. Their specific responsibilities vary, but administrative service managers typically maintain facilities and supervise activities that include recordkeeping, mail distribution, and office upkeep.
view profile »Computer and Information Systems Managers
Computer and information systems managers, often called information technology (IT) managers or IT project managers, plan, coordinate, and direct computer-related activities in an organization. They help determine the information technology goals of an organization and are responsible for implementing computer systems to meet those goals.
view profile »Financial Managers
Financial managers are responsible for the financial health of an organization. They produce financial reports, direct investment activities, and develop strategies and plans for the long-term financial goals of their organization.
view profile »Compensation and Benefits Managers
Compensation managers plan, develop, and oversee programs to determine how much an organization pays its employees and how employees are paid. Benefits managers plan, direct, and coordinate retirement plans, health insurance, and other benefits that an organization offers its employees.
view profile »Training and Development Managers
Training and development managers oversee staff and plan, direct, and coordinate programs to enhance the knowledge and skills of an organization’s employees.
view profile »Human Resources Managers
Human resources managers plan, direct, and coordinate the administrative functions of an organization. They oversee the recruiting, interviewing, and hiring of new staff; consult with top executives on strategic planning; and serve as a link between an organization’s management and its employees.
view profile »Industrial Production Managers
Industrial production managers oversee the daily operations of manufacturing and related plants. They coordinate, plan, and direct the activities used to create a wide range of goods, such as cars, computer equipment, or paper products.
view profile »- Farmers, Ranchers, and Other Agricultural Managers
Farmers, Ranchers, and Other Agricultural Managers
Farmers, ranchers, and other agricultural managers operate establishments that produce crops, livestock, and dairy products.
view profile » - Construction Managers
Construction Managers
Construction managers plan, coordinate, budget, and supervise construction projects from start to finish.
view profile » - Preschool and Childcare Center Directors
Preschool and Childcare Center Directors
Preschool and childcare center directors supervise and lead their staffs, design program plans, oversee daily activities, and prepare budgets. They are responsible for all aspects of their center’s program.
view profile » - Elementary, Middle, and High School Principals
Elementary, Middle, and High School Principals
Elementary, middle, and high school principals oversee all school operations, including daily school activities. They coordinate curriculums, manage staff, and provide a safe and productive learning environment for students.
view profile » - Postsecondary Education Administrators
Postsecondary Education Administrators
Postsecondary education administrators oversee student services, academics, and faculty research at colleges and universities. Their job duties vary depending on the area of the college they manage, such as admissions, student life, or the registrar’s office.
view profile » - Architectural and Engineering Managers
Architectural and Engineering Managers
Architectural and engineering managers plan, direct, and coordinate activities in architectural and engineering companies.
view profile » - Food Service Managers
Food Service Managers
Food service managers are responsible for the daily operation of restaurants or other establishments that prepare and serve food and beverages. They direct staff to ensure that customers are satisfied with their dining experience, and they manage the business to ensure that it is profitable.
view profile » - Lodging Managers
Lodging Managers
Lodging managers ensure that guests on vacation or business travel have a pleasant experience at a hotel, motel, or other types of establishment with accommodations. They also ensure that the establishment is run efficiently and profitably.
view profile » - Medical and Health Services Managers
Medical and Health Services Managers
Medical and health services managers, also called healthcare executives or healthcare administrators, plan, direct, and coordinate medical and health services. They might manage an entire facility, a specific clinical area or department, or a medical practice for a group of physicians. Medical and health services managers must direct changes that conform to changes in healthcare laws, regulations, and technology.
view profile » - Natural Sciences Managers
Natural Sciences Managers
Natural sciences managers supervise the work of scientists, including chemists, physicists, and biologists. They direct activities related to research and development, and coordinate activities such as testing, quality control, and production.
view profile » - Property, Real Estate, and Community Association Managers
Property, Real Estate, and Community Association Managers
Property, real estate, and community association managers take care of the many aspects of residential, commercial, or industrial properties. They make sure the property is well maintained, has a nice appearance, and preserves its resale or leasing value.
view profile » - Social and Community Service Managers
Social and Community Service Managers
Social and community service managers coordinate and supervise social service programs and community organizations. They manage workers who provide social services to the public.
view profile » - Top Executives
Top Executives
Top executives devise strategies and policies to ensure that an organization meets its goals. They plan, direct, and coordinate operational activities of companies and organizations.
view profile » - Claims Adjusters, Appraisers, Examiners, and Investigators
Claims Adjusters, Appraisers, Examiners, and Investigators
Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim, and if so, how much.
view profile » - Cost Estimators
Cost Estimators
Cost estimators collect and analyze data in order to estimate the time, money, materials, and labor required to manufacture a product, construct a building, or provide a service. They generally specialize in a particular product or industry.
view profile » - Human Resources Specialists
Human Resources Specialists
Human resources specialists recruit, screen, interview, and place workers. They often handle other human resources work, such as those related to employee relations, compensation and benefits, and training.
view profile » - Management Analysts
Management Analysts
Management analysts, often called management consultants, propose ways to improve an organization’s efficiency. They advise managers on how to make organizations more profitable through reduced costs and increased revenues.
view profile » - Meeting, Convention, and Event Planners
Meeting, Convention, and Event Planners
Meeting, convention, and event planners coordinate all aspects of events and professional meetings. They arrange meeting locations, transportation, and other details.
view profile » - Accountants and Auditors
Accountants and Auditors
Accountants and auditors prepare and examine financial records. They ensure that financial records are accurate and that taxes are paid properly and on time. Accountants and auditors assess financial operations and work to help ensure that organizations run efficiently.
view profile » - Appraisers and Assessors of Real Estate
Appraisers and Assessors of Real Estate
Appraisers and assessors of real estate provide a value estimate on land and buildings usually before they are sold, mortgaged, taxed, insured, or developed.
view profile » - Budget Analysts
Budget Analysts
Budget analysts help public and private institutions organize their finances. They prepare budget reports and monitor institutional spending.
view profile » - Financial Analysts
Financial Analysts
Financial analysts provide guidance to businesses and individuals making investment decisions. They assess the performance of stocks, bonds, and other types of investments.
view profile » - Personal Financial Advisors
Personal Financial Advisors
Personal financial advisors provide advice on investments, insurance, mortgages, college savings, estate planning, taxes, and retirement to help individuals manage their finances.
view profile » - Financial Examiners
Financial Examiners
Financial examiners ensure compliance with laws governing financial institutions and transactions. They review balance sheets, evaluate the risk level of loans, and assess bank management.
view profile » - Loan Officers
Loan Officers
Loan officers evaluate, authorize, or recommend approval of loan applications for people and businesses.
view profile » - Tax Examiners and Collectors, and Revenue Agents
Tax Examiners and Collectors, and Revenue Agents
Tax examiners and collectors, and revenue agents determine how much is owed in taxes and collect tax from individuals and businesses on behalf of federal, state, and local governments. They review tax returns, conduct audits, identify taxes owed, and collect overdue tax payments.
view profile » - Computer Programmers
Computer Programmers
Computer programmers write and test code that allows computer applications and software programs to function properly. They turn the program designs created by software developers and engineers into instructions that a computer can follow.
view profile » - Software Developers
Software Developers
Software developers are the creative minds behind computer programs. Some develop the applications that allow people to do specific tasks on a computer or another device. Others develop the underlying systems that run the devices or that control networks.
view profile » - Computer Support Specialists
Computer Support Specialists
Computer support specialists provide help and advice to computer users and organizations. These specialists either support computer networks or they provide technical assistance directly to computer users.
view profile » - Computer Systems Analysts
Computer Systems Analysts
Computer systems analysts, sometimes called systems architects, study an organization’s current computer systems and procedures, and design solutions to help the organization operate more efficiently and effectively. They bring business and information technology (IT) together by understanding the needs and limitations of both.
view profile » - Database Administrators
Database Administrators
Database administrators (DBAs) use specialized software to store and organize data, such as financial information and customer shipping records. They make sure that data are available to users and secure from unauthorized access.
view profile » - Network and Computer Systems Administrators
Network and Computer Systems Administrators
Computer networks are critical parts of almost every organization. Network and computer systems administrators are responsible for the day-to-day operation of these networks.
view profile » - Actuaries
Actuaries
Actuaries analyze the financial costs of risk and uncertainty. They use mathematics, statistics, and financial theory to assess the risk of potential events, and they help businesses and clients develop policies that minimize the cost of that risk. Actuaries’ work is essential to the insurance industry.
view profile » - Operations Research Analysts
Operations Research Analysts
Operations research analysts use advanced mathematical and analytical methods to help organizations investigate complex issues, identify and solve problems, and make better decisions.
view profile » - Architects
Architects
Architects plan and design houses, factories, office buildings, and other structures.
view profile » - Landscape Architects
Landscape Architects
Landscape architects design parks and the outdoor spaces of campuses, recreational facilities, private homes, and other open areas.
view profile » - Cartographers and Photogrammetrists
Cartographers and Photogrammetrists
Cartographers and photogrammetrists collect, measure, and interpret geographic information in order to create and update maps and charts for regional planning, education, emergency response, and other purposes.
view profile » - Surveyors
Surveyors
Surveyors make precise measurements to determine property boundaries. They provide data relevant to the shape and contour of the Earth’s surface for engineering, mapmaking, and construction projects.
view profile » - Aerospace Engineers
Aerospace Engineers
Aerospace engineers design primarily aircraft, spacecraft, satellites, and missiles. In addition, they test prototypes to make sure that they function according to design.
view profile » - Biomedical Engineers
Biomedical Engineers
Biomedical engineers combine engineering principles with medical sciences to design and create equipment, devices, computer systems, and software used in healthcare.
view profile » - Chemical Engineers
Chemical Engineers
Chemical engineers apply the principles of chemistry, biology, physics, and math to solve problems that involve the production or use of chemicals, fuel, drugs, food, and many other products. They design processes and equipment for large-scale manufacturing, plan and test production methods and byproducts treatment, and direct facility operations.
view profile » - Civil Engineers
Civil Engineers
Civil engineers conceive, design, build, supervise, operate, construct, and maintain infrastructure projects and systems in the public and private sector, including roads, buildings, airports, tunnels, dams, bridges, and systems for water supply and sewage treatment.
view profile » - Computer Hardware Engineers
Computer Hardware Engineers
Computer hardware engineers research, design, develop, and test computer systems and components such as processors, circuit boards, memory devices, networks, and routers.
view profile » - Electrical and Electronics Engineers
Electrical and Electronics Engineers
Electrical engineers design, develop, test, and supervise the manufacturing of electrical equipment, such as electric motors, radar and navigation systems, communications systems, and power generation equipment. Electronics engineers design and develop electronic equipment, including broadcast and communications systems, such as portable music players and Global Positioning System (GPS) devices.
view profile » - Environmental Engineers
Environmental Engineers
Environmental engineers use the principles of engineering, soil science, biology, and chemistry to develop solutions to environmental problems. They work to improve recycling, waste disposal, public health, and water and air pollution control.
view profile » - Industrial Engineers
Industrial Engineers
Industrial engineers find ways to eliminate wastefulness in production processes. They devise efficient systems that integrate workers, machines, materials, information, and energy to make a product or provide a service.
view profile » - Marine Engineers and Naval Architects
Marine Engineers and Naval Architects
Marine engineers and naval architects design, build, and maintain ships, from aircraft carriers to submarines and from sailboats to tankers. Marine engineers are responsible for the internal systems of a ship, such as the propulsion, electrical, refrigeration, and steering systems. Naval architects are responsible for the ship design, including the form, structure, and stability of hulls.
view profile » - Materials Engineers
Materials Engineers
Materials engineers develop, process, and test materials used to create a wide range of products, from computer chips and aircraft wings to golf clubs and biomedical devices. They study the properties and structures of metals, ceramics, plastics, composites, nanomaterials (extremely small substances), and other substances in order to create new materials that meet certain mechanical, electrical, and chemical requirements.
view profile » - Mechanical Engineers
Mechanical Engineers
Mechanical engineers design, develop, build, and test mechanical and thermal sensors and devices, including tools, engines, and machines.
view profile » - Mining and Geological Engineers
Mining and Geological Engineers
Mining and geological engineers design mines to safely and efficiently remove minerals such as coal and metals for use in manufacturing and utilities.
view profile » - Nuclear Engineers
Nuclear Engineers
Nuclear engineers research and develop the processes, instruments, and systems used to derive benefits from nuclear energy and radiation. Many of these engineers find industrial and medical uses for radioactive materials—for example, in equipment used in medical diagnosis and treatment.
view profile » - Petroleum Engineers
Petroleum Engineers
Petroleum engineers design and develop methods for extracting oil and gas from deposits below the Earth’s surface. Petroleum engineers also find new ways to extract oil and gas from older wells.
view profile » - Drafters
Drafters
Drafters use software to convert the designs of engineers and architects into technical drawings. Most workers specialize in architectural, civil, electrical, or mechanical drafting and use technical drawings to help design everything from microchips to skyscrapers.
view profile » - Civil Engineering Technicians
Civil Engineering Technicians
Civil engineering technicians help civil engineers to plan, design, and build highways, bridges, utilities, and other infrastructure projects. They also help to plan, design, and build commercial, industrial, residential, and land development projects.
view profile » - Environmental Engineering Technicians
Environmental Engineering Technicians
Environmental engineering technicians carry out the plans that environmental engineers develop. They test, operate, and, if necessary, modify equipment used to prevent or clean up environmental pollution. They may collect samples for testing, or they may work to mitigate sources of environmental pollution.
view profile » - Industrial Engineering Technicians
Industrial Engineering Technicians
Industrial engineering technicians assist industrial engineers in devising efficient systems that integrate workers, machines, materials, information, and energy to make a product or provide a service. They prepare machinery and equipment layouts, plan workflows, conduct statistical production studies, and analyze production costs.
view profile » - Mechanical Engineering Technicians
Mechanical Engineering Technicians
Mechanical engineering technicians help mechanical engineers design, develop, test, and manufacture mechanical devices, including tools, engines, and machines. They may make sketches and rough layouts, record and analyze data, make calculations and estimates, and report their findings.
view profile » - Market Research Analysts
Market Research Analysts
Market research analysts study market conditions to examine potential sales of a product or service. They help companies understand what products people want, who will buy them, and at what price.
view profile » - Surveying and Mapping Technicians
Surveying and Mapping Technicians
Surveying and mapping technicians collect data and make maps of the Earth&apos:s surface. Surveying technicians visit sites to take measurements of the land. Mapping technicians use geographic data to create maps. They both assist surveyors and cartographers and photogrammetrists.
view profile » - Agricultural and Food Scientists
Agricultural and Food Scientists
Agricultural and food scientists research ways to improve the efficiency and safety of agricultural establishments and products.
view profile » - Biochemists and Biophysicists
Biochemists and Biophysicists
Biochemists and biophysicists study the chemical and physical principles of living things and of biological processes, such as cell development, growth, heredity, and disease.
view profile » - Microbiologists
Microbiologists
Microbiologists study microorganisms such as bacteria, viruses, algae, fungi, and some types of parasites. They try to understand how these organisms live, grow, and interact with their environments.
view profile » - Zoologists and Wildlife Biologists
Zoologists and Wildlife Biologists
Zoologists and wildlife biologists study animals and other wildlife and how they interact with their ecosystems. They study the physical characteristics of animals, animal behaviors, and the impacts humans have on wildlife and natural habitats.
view profile » - Epidemiologists
Epidemiologists
Epidemiologists are public health professionals who investigate patterns and causes of disease and injury in humans. They seek to reduce the risk and occurrence of negative health outcomes through research, community education, and health policy.
view profile » - Medical Scientists
Medical Scientists
Medical scientists conduct research aimed at improving overall human health. They often use clinical trials and other investigative methods to reach their findings.
view profile » - Physicists and Astronomers
Physicists and Astronomers
Physicists and astronomers study the ways in which various forms of matter and energy interact. Theoretical physicists and astronomers may study the nature of time or the origin of the universe. Some physicists design and perform experiments with sophisticated equipment such as particle accelerators, electron microscopes, and lasers.
view profile » - Chemists and Materials Scientists
Chemists and Materials Scientists
Chemists and materials scientists study substances at the atomic and molecular levels and analyze the ways in which the substances interact with one another. They use their knowledge to develop new and improved products and to test the quality of manufactured goods.
view profile » - Environmental Scientists and Specialists
Environmental Scientists and Specialists
Environmental scientists and specialists use their knowledge of the natural sciences to protect the environment and human health. They may clean up polluted areas, advise policymakers, or work with industry to reduce waste.
view profile » - Geoscientists
Geoscientists
Geoscientists study the physical aspects of the Earth, such as its composition, structure, and processes, to learn about its past, present, and future.
view profile » - Hydrologists
Hydrologists
Hydrologists study how water moves across and through the Earth’s crust. They use their expertise to solve problems in the areas of water quality or availability.
view profile » - Survey Researchers
Survey Researchers
Survey researchers design and conduct surveys and analyze data. Surveys are used to collect factual data, such as employment and salary information, or to ask questions in order to understand people’s opinions, preferences, beliefs, or desires.
view profile » - Psychologists
Psychologists
Psychologists study cognitive, emotional, and social processes and behavior by observing, interpreting, and recording how individuals relate to one another and to their environments. They use their findings to help improve processes and behaviors.
view profile » - Sociologists
Sociologists
Sociologists study society and social behavior by examining the groups, cultures, organizations, social institutions, and processes that develop when people interact and work together.
view profile » - Urban and Regional Planners
Urban and Regional Planners
Urban and regional planners develop land use plans and programs that help create communities, accommodate population growth, and revitalize physical facilities in towns, cities, counties, and metropolitan areas.
view profile » - Anthropologists and Archeologists
Anthropologists and Archeologists
Anthropologists and archeologists study the origin, development, and behavior of humans. They examine the cultures, languages, archeological remains, and physical characteristics of people in various parts of the world.
view profile » - Political Scientists
Political Scientists
Political scientists study the origin, development, and operation of political systems. They research political ideas and analyze governments, policies, political trends, and related issues.
view profile » - Biological Technicians
Biological Technicians
Biological technicians help biological and medical scientists conduct laboratory tests and experiments.
view profile » - Chemical Technicians
Chemical Technicians
Chemical technicians use special instruments and techniques to help chemists and chemical engineers research, develop, produce, and test chemical products and processes.
view profile » - Geological and Petroleum Technicians
Geological and Petroleum Technicians
Geological and petroleum technicians provide support to scientists and engineers in exploring and extracting natural resources, such as minerals, oil, and natural gas.
view profile » - Nuclear Technicians
Nuclear Technicians
Nuclear technicians assist physicists, engineers, and other professionals in nuclear research and nuclear energy production. They operate special equipment and monitor the levels of radiation that are produced.
view profile » - Environmental Science and Protection Technicians
Environmental Science and Protection Technicians
Environmental science and protection technicians monitor the environment and investigate sources of pollution and contamination, including those affecting public health.
view profile » - Forensic Science Technicians
Forensic Science Technicians
Forensic science technicians aid criminal investigations by collecting and analyzing evidence. Many technicians specialize in various types of laboratory analysis.
view profile » - Substance Abuse, Behavioral Disorder, and Mental Health Counselors
Substance Abuse, Behavioral Disorder, and Mental Health Counselors
Substance abuse, behavioral disorder, and mental health counselors advise people who suffer from alcoholism, drug addiction, eating disorders, mental health issues, or other mental or behavioral problems. They provide treatment and support to help clients recover from addiction or modify problem behaviors.
view profile » - School and Career Counselors
School and Career Counselors
School counselors help students develop the academic and social skills needed to succeed in school. Career counselors help people choose careers and follow a path to employment.
view profile » - Marriage and Family Therapists
Marriage and Family Therapists
Marriage and family therapists help people manage and overcome problems with family and other relationships.
view profile » - Rehabilitation Counselors
Rehabilitation Counselors
Rehabilitation counselors help people with physical, mental, developmental, or emotional disabilities live independently. They work with clients to overcome or manage the personal, social, or psychological effects of disabilities on employment or independent living.
view profile » - Social Workers
Social Workers
Social workers help people solve and cope with problems in their everyday lives. Clinical social workers also diagnose and treat mental, behavioral, and emotional issues.
view profile » - Probation Officers and Correctional Treatment Specialists
Probation Officers and Correctional Treatment Specialists
Probation officers and correctional treatment specialists provide social services to assist in rehabilitation of law offenders in custody or on probation or parole.
view profile » - Social and Human Service Assistants
Social and Human Service Assistants
Social and human service assistants provide client services, including support for families, in a wide variety of fields, such as psychology, rehabilitation, and social work. They assist other workers, such as social workers, and they help clients find benefits or community services.
view profile » - Lawyers
Lawyers
Lawyers advise and represent individuals, businesses, and government agencies on legal issues and disputes.
view profile » - Paralegals and Legal Assistants
Paralegals and Legal Assistants
Paralegals and legal assistants perform a variety of tasks to support lawyers, including maintaining and organizing files, conducting legal research, and drafting documents.
view profile » - Postsecondary Teachers
Postsecondary Teachers
Postsecondary teachers instruct students in a wide variety of academic and technical subjects beyond the high school level. They may also conduct research and publish scholarly papers and books.
view profile » - Preschool Teachers
Preschool Teachers
Preschool teachers educate and care for children younger than age 5 who have not yet entered kindergarten. They teach language, motor, and social skills to young children.
view profile » - Kindergarten and Elementary School Teachers
Kindergarten and Elementary School Teachers
Kindergarten and elementary school teachers instruct young students in basic subjects, such as math and reading, in order to prepare them for future schooling.
view profile » - Middle School Teachers
Middle School Teachers
Middle school teachers educate students, typically in sixth through eighth grades. They help students build on the fundamentals they learned in elementary school and prepare them for the more difficult curriculum they will face in high school.
view profile » - Career and Technical Education Teachers
Career and Technical Education Teachers
Career and technical education teachers instruct students in various technical and vocational subjects, such as auto repair, healthcare, and culinary arts. They teach academic and technical content to provide students with the skills and knowledge necessary to enter an occupation.
view profile » - Special Education Teachers
Special Education Teachers
Special education teachers work with students who have a wide range of learning, mental, emotional, and physical disabilities. They adapt general education lessons and teach various subjects, such as reading, writing, and math, to students with mild and moderate disabilities. They also teach basic skills, such as literacy and communication techniques, to students with severe disabilities.
view profile » - Adult Literacy and High School Equivalency Diploma Teachers
Adult Literacy and High School Equivalency Diploma Teachers
Adult literacy and high school equivalency diploma teachers instruct adults in basic skills, such as reading, writing, and speaking English. They also help students earn their high school equivalent diploma.
view profile » - Archivists, Curators, and Museum Workers
Archivists, Curators, and Museum Workers
Archivists appraise, process, catalog, and preserve permanent records and historically valuable documents. Curators oversee collections of artwork and historic items, and may conduct public service activities for an institution. Museum technicians and conservators prepare and restore objects and documents in museum collections and exhibits.
view profile » - Librarians
Librarians
Librarians help people find information and conduct research for personal and professional use. Their job duties may change based on the type of library they work in, such as public, academic, and medical libraries.
view profile » - Library Technicians and Assistants
Library Technicians and Assistants
Library technicians and assistants help librarians with all aspects of running a library. They assist patrons, organize library materials and information, and perform clerical and administrative tasks.
view profile » - Instructional Coordinators
Instructional Coordinators
Instructional coordinators oversee school curriculums and teaching standards. They develop instructional material, coordinate its implementation with teachers and principals, and assess its effectiveness.
view profile » - Teacher Assistants
Teacher Assistants
Teacher assistants work under a teacher’s supervision to give students additional attention and instruction.
view profile » - Art Directors
Art Directors
Art directors are responsible for the visual style and images in magazines, newspapers, product packaging, and movie and television productions. They create the overall design of a project and direct others who develop artwork and layouts.
view profile » - Multimedia Artists and Animators
Multimedia Artists and Animators
Multimedia artists and animators create images that appear to move and visual effects for television, movies, video games, and other forms of media.
view profile » - Industrial Designers
Industrial Designers
Industrial designers develop the concepts for manufactured products, such as cars, home appliances, and toys. They combine art, business, and engineering to make products that people use every day. Industrial designers consider the function, aesthetics, production costs, and usability of products when developing new product concepts.
view profile » - Fashion Designers
Fashion Designers
Fashion designers create clothing, accessories, and footwear. They sketch designs, select fabrics and patterns, and oversee their products’ creation.
view profile » - Floral Designers
Floral Designers
Floral designers, also called florists, arrange live, dried, and silk flowers and greenery to make decorative displays. They also help customers select flowers and containers, ribbons, and other accessories.
view profile » - Graphic Designers
Graphic Designers
Graphic designers create visual concepts, using computer software or by hand, to communicate ideas that inspire, inform, and captivate consumers. They develop the overall layout and production design for applications such as advertisements, brochures, magazines, and reports.
view profile » - Interior Designers
Interior Designers
Interior designers make indoor spaces functional, safe, and beautiful by determining space requirements and selecting essential and decorative items, such as colors, lighting, and materials. They must be able to draw, read and edit blueprints. They also must be aware of building codes, inspection regulations, and other considerations, such as accessibility standards.
view profile » - Actors
Actors
Actors express ideas and portray characters in theater, film, television, and other performing arts media. They interpret a writer’s script to entertain or inform an audience.
view profile » - Producers and Directors
Producers and Directors
Producers and directors create motion pictures, television shows, live theater, commercials, and other performing arts productions. They interpret a writer’s script to entertain or inform an audience.
view profile » - Athletes and Sports Competitors
Athletes and Sports Competitors
Athletes and sports competitors participate in organized, officiated sporting events to entertain spectators.
view profile » - Coaches and Scouts
Coaches and Scouts
Coaches teach amateur or professional athletes the skills they need to succeed at their sport. Scouts look for new players and evaluate their skills and likelihood for success at the college, amateur, or professional level. Many coaches also are involved in scouting.
view profile » - Umpires, Referees, and Other Sports Officials
Umpires, Referees, and Other Sports Officials
Umpires, referees, and other sports officials preside over competitive athletic or sporting events to help maintain standards of play. They detect infractions and decide penalties according to the rules of the game.
view profile » - Dancers and Choreographers
Dancers and Choreographers
Dancers and choreographers use dance performances to express ideas and stories. There are many types of dance, such as ballet, tango, modern dance, tap, and jazz.
view profile » - Music Directors and Composers
Music Directors and Composers
Music directors, also called conductors, lead orchestras and other musical groups during performances and recording sessions. Composers write and arrange original music in a variety of musical styles.
view profile » - Musicians and Singers
Musicians and Singers
Musicians and singers play instruments or sing for live audiences and in recording studios.
view profile » - Announcers
Announcers
Announcers present music, news, and sports and may provide commentary or interview guests about these or other important topics. Some act as masters of ceremonies (emcees) or disc jockeys (DJs) at weddings, parties, or clubs.
view profile » - Reporters, Correspondents, and Broadcast News Analysts
Reporters, Correspondents, and Broadcast News Analysts
Reporters, correspondents, and broadcast news analysts inform the public about news and events happening internationally, nationally, and locally. They report the news for newspapers, magazines, websites, television, and radio.
view profile » - Editors
Editors
Editors plan, review, and revise content for publication.
view profile » - Technical Writers
Technical Writers
Technical writers, also called technical communicators, prepare instruction manuals, how-to guides, journal articles, and other supporting documents to communicate complex and technical information more easily. They also develop, gather, and disseminate technical information through an organization’s communications channels.
view profile » - Writers and Authors
Writers and Authors
Writers and authors develop written content for various types of media, including advertisements; books; magazines; movie, play, and television scripts; and blogs.
view profile » - Interpreters and Translators
Interpreters and Translators
Interpreters and translators convert information from one language into another language. Interpreters work in spoken or sign language; translators work in written language.
view profile » - Broadcast and Sound Engineering Technicians
Broadcast and Sound Engineering Technicians
Broadcast and sound engineering technicians set up, operate, and maintain the electrical equipment for radio programs, television broadcasts, concerts, sound recordings, and movies.
view profile » - Photographers
Photographers
Photographers use their technical expertise, creativity, and composition skills to produce and preserve images that tell a story or record an event.
view profile » - Film and Video Editors and Camera Operators
Film and Video Editors and Camera Operators
Film and video editors and camera operators manipulate moving images that entertain or inform an audience.
view profile » - Chiropractors
Chiropractors
Chiropractors treat patients with health problems of the neuromusculoskeletal system, which includes nerves, bones, muscles, ligaments, and tendons. They use spinal adjustments and manipulation, as well as other clinical interventions, to manage patients’ health concerns, such as back and neck pain.
view profile » - Dentists
Dentists
Dentists diagnose and treat problems with patients’ teeth, gums, and related parts of the mouth. They provide advice and instruction on taking care of the teeth and gums and on diet choices that affect oral health.
view profile » - Optometrists
Optometrists
Optometrists examine the eyes and other parts of the visual system. They also diagnose and treat visual problems and manage diseases, injuries, and other disorders of the eyes. They prescribe eyeglasses or contact lenses as needed.
view profile » - Pharmacists
Pharmacists
Pharmacists dispense prescription medications to patients and offer expertise in the safe use of prescriptions. They also may conduct health and wellness screenings, provide immunizations, oversee the medications given to patients, and provide advice on healthy lifestyles.
view profile » - Physicians and Surgeons
Physicians and Surgeons
Physicians and surgeons diagnose and treat injuries or illnesses. Physicians examine patients; take medical histories; prescribe medications; and order, perform, and interpret diagnostic tests. They counsel patients on diet, hygiene, and preventive healthcare. Surgeons operate on patients to treat injuries, such as broken bones; diseases, such as cancerous tumors; and deformities, such as cleft palates.
view profile » - Physician Assistants
Physician Assistants
Physician assistants, also known as PAs, practice medicine on teams with physicians, surgeons, and other healthcare workers. They examine, diagnose, and treat patients.
view profile » - Podiatrists
Podiatrists
Podiatrists provide medical and surgical care for people with foot, ankle, and lower leg problems. They diagnose illnesses, treat injuries, and perform surgery involving the lower extremities.
view profile » - Registered Nurses
Registered Nurses
Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.
view profile » - Occupational Therapists
Occupational Therapists
Occupational therapists treat injured, ill, or disabled patients through the therapeutic use of everyday activities. They help these patients develop, recover, improve, as well as maintain the skills needed for daily living and working.
view profile » - Physical Therapists
Physical Therapists
Physical therapists, sometimes called PTs, help injured or ill people improve their movement and manage their pain. These therapists are often an important part of the rehabilitation, treatment, and prevention of patients with chronic conditions, illnesses, or injuries.
view profile » - Radiation Therapists
Radiation Therapists
Radiation therapists treat cancer and other diseases in patients by administering radiation treatments.
view profile » - Recreational Therapists
Recreational Therapists
Recreational therapists plan, direct, and coordinate recreation-based treatment programs for people with disabilities, injuries, or illnesses. These therapists use a variety of modalities, including arts and crafts; drama, music, and dance; sports and games; aquatics; and community outings to help maintain or improve a patient’s physical, social, and emotional well-being.
view profile » - Respiratory Therapists
Respiratory Therapists
Respiratory therapists care for patients who have trouble breathing—for example, from a chronic respiratory disease, such as asthma or emphysema. Their patients range from premature infants with undeveloped lungs to elderly patients who have diseased lungs. They also provide emergency care to patients suffering from heart attacks, drowning, or shock.
view profile » - Speech-Language Pathologists
Speech-Language Pathologists
Speech-language pathologists (sometimes called speech therapists) assess, diagnose, treat, and help to prevent communication and swallowing disorders in children and adults. Speech, language, and swallowing disorders result from a variety of causes, such as a stroke, brain injury, hearing loss, developmental delay, Parkinson’s disease, a cleft palate, or autism.
view profile » - Veterinarians
Veterinarians
Veterinarians care for the health of animals and work to protect public health. They diagnose, treat, and research medical conditions and diseases of pets, livestock, and other animals.
view profile » - Medical and Clinical Laboratory Technologists and Technicians
Medical and Clinical Laboratory Technologists and Technicians
Medical laboratory technologists (commonly known as medical laboratory scientists) and medical laboratory technicians collect samples and perform tests to analyze body fluids, tissue, and other substances.
view profile » - Dental Hygienists
Dental Hygienists
Dental hygienists clean teeth, examine patients for signs of oral diseases such as gingivitis, and provide other preventive dental care. They also educate patients on ways to improve and maintain good oral health.
view profile » - Diagnostic Medical Sonographers and Cardiovascular Technologists and Technicians, Including Vascular Technologists
Diagnostic Medical Sonographers and Cardiovascular Technologists and Technicians, Including Vascular Technologists
Diagnostic medical sonographers and cardiovascular technologists and technicians, including vascular technologists, also called diagnostic imaging workers, operate special imaging equipment to create images or to conduct tests. The images and test results help physicians assess and diagnose medical conditions.
view profile » - Nuclear Medicine Technologists
Nuclear Medicine Technologists
Nuclear medicine technologists prepare radioactive drugs and administer them to patients for imaging or therapeutic purposes.
view profile » - Radiologic and MRI Technologists
Radiologic and MRI Technologists
Radiologic technologists, also known as radiographers, perform diagnostic imaging examinations, such as x rays, on patients. MRI technologists operate magnetic resonance imaging (MRI) scanners to create diagnostic images.
view profile » - EMTs and Paramedics
EMTs and Paramedics
Emergency medical technicians (EMTs) and paramedics care for the sick or injured in emergency medical settings. People’s lives often depend on the quick reaction and competent care provided by these workers. EMTs and paramedics respond to emergency calls, performing medical services and transporting patients to medical facilities.
view profile » - Pharmacy Technicians
Pharmacy Technicians
Pharmacy technicians help pharmacists dispense prescription medication to customers or health professionals.
view profile » - Surgical Technologists
Surgical Technologists
Surgical technologists, also called operating room technicians, assist in surgical operations. They prepare operating rooms, arrange equipment, and help doctors during surgeries.
view profile » - Veterinary Technologists and Technicians
Veterinary Technologists and Technicians
Veterinary technologists and technicians, supervised by licensed veterinarians, do medical tests that help diagnose animals’ injuries and illnesses.
view profile » - Licensed Practical and Licensed Vocational Nurses
Licensed Practical and Licensed Vocational Nurses
Licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) provide basic nursing care. They work under the direction of registered nurses and doctors.
view profile » - Medical Records and Health Information Technicians
Medical Records and Health Information Technicians
Medical records and health information technicians, commonly referred to as health information technicians, organize and manage health information data. They ensure its quality, accuracy, accessibility, and security in both paper and electronic systems. They use various classification systems to code and categorize patient information for insurance reimbursement purposes, for databases and registries, and to maintain patients’ medical and treatment histories.
view profile » - Opticians
Opticians
Opticians help fit eyeglasses and contact lenses, following prescriptions from ophthalmologists and optometrists. They also help customers decide which eyeglass frames or contact lenses to buy.
view profile » - Occupational Health and Safety Specialists and Technicians
Occupational Health and Safety Specialists and Technicians
Occupational health and safety specialists and technicians collect data on and analyze many types of work environments and work procedures. Specialists inspect workplaces for adherence to regulations on safety, health, and the environment. Technicians work with specialists in conducting tests and measuring hazards to help prevent harm to workers, property, the environment, and the general public.
view profile » - Athletic Trainers
Athletic Trainers
Athletic trainers specialize in preventing, diagnosing, and treating muscle and bone injuries and illnesses.
view profile » - Home Health Aides and Personal Care Aides
Home Health Aides and Personal Care Aides
Home health aides and personal care aides help people with disabilities, chronic illnesses, or cognitive impairment by assisting in their daily living activities. They often help older adults who need assistance. In some states, home health aides may be able to give a client medication or check the client’s vital signs under the direction of a nurse or other healthcare practitioner.
view profile » - Nursing Assistants and Orderlies
Nursing Assistants and Orderlies
Nursing assistants, sometimes called nursing aides, help provide basic care for patients in hospitals and residents of long-term care facilities, such as nursing homes. Orderlies transport patients and clean treatment areas.
view profile » - Psychiatric Technicians and Aides
Psychiatric Technicians and Aides
Psychiatric technicians and aides care for people who have mental illness and developmental disabilities. Technicians typically provide therapeutic care and monitor their patients’ conditions. Aides help patients in their daily activities and ensure a safe, clean environment.
view profile » - Occupational Therapy Assistants and Aides
Occupational Therapy Assistants and Aides
Occupational therapy assistants and aides help patients develop, recover, improve, as well as maintain the skills needed for daily living and working. Occupational therapy assistants are directly involved in providing therapy to patients; occupational therapy aides typically perform support activities. Both assistants and aides work under the direction of occupational therapists.
view profile » - Physical Therapist Assistants and Aides
Physical Therapist Assistants and Aides
Physical therapist assistants, sometimes called PTAs, and physical therapist aides work under the direction and supervision of physical therapists. They help patients who are recovering from injuries and illnesses regain movement and manage pain.
view profile » - Massage Therapists
Massage Therapists
Massage therapists treat clients by using touch to manipulate the muscles and other soft tissues of the body. With their touch, therapists relieve pain, help heal injuries, improve circulation, relieve stress, increase relaxation, and aid in the general wellness of clients.
view profile » - Dental Assistants
Dental Assistants
Dental assistants perform many tasks, ranging from providing patient care and taking x rays to recordkeeping and scheduling appointments. Their duties vary by state and by the dentists’ offices where they work.
view profile » - Medical Assistants
Medical Assistants
Medical assistants complete administrative and clinical tasks in the offices of physicians, hospitals, and other healthcare facilities. Their duties vary with the location, specialty, and size of the practice.
view profile » - Medical Transcriptionists
Medical Transcriptionists
Medical transcriptionists, sometimes referred to as healthcare documentation specialists, listen to voice recordings that physicians and other healthcare workers make and convert them into written reports. They also may review and edit medical documents created using speech recognition technology. Transcriptionists interpret medical terminology and abbreviations in preparing patients’ medical histories, discharge summaries, and other documents.
view profile » - Firefighters
Firefighters
Firefighters control and put out fires and respond to emergencies where life, property, or the environment is at risk.
view profile » - Correctional Officers and Bailiffs
Correctional Officers and Bailiffs
Correctional officers are responsible for overseeing individuals who have been arrested and are awaiting trial or who have been sentenced to serve time in jail or prison. Bailiffs are law enforcement officers who maintain safety and order in courtrooms.
view profile » - Police and Detectives
Police and Detectives
Police officers protect lives and property. Detectives and criminal investigators, who are sometimes called agents or special agents, gather facts and collect evidence of possible crimes.
view profile » - Private Detectives and Investigators
Private Detectives and Investigators
Private detectives and investigators search for information about legal, financial, and personal matters. They offer many services, such as verifying people’s backgrounds and statements, finding missing persons, and investigating computer crimes.
view profile » - Security Guards and Gaming Surveillance Officers
Security Guards and Gaming Surveillance Officers
Security guards and gaming surveillance officers patrol and protect property against theft, vandalism, and other illegal activity.
view profile » - Chefs and Head Cooks
Chefs and Head Cooks
Chefs and head cooks oversee the daily food preparation at restaurants and other places where food is served. They direct kitchen staff and handle any food-related concerns.
view profile » - Cooks
Cooks
Cooks prepare, season, and cook a wide range of foods, which may include soups, salads, entrees, and desserts.
view profile » - Food Preparation Workers
Food Preparation Workers
Food preparation workers perform many routine tasks under the direction of cooks, chefs, or food service managers. Food preparation workers prepare cold foods, slice meat, peel and cut vegetables, brew coffee or tea, and perform many other food service tasks.
view profile » - Bartenders
Bartenders
Bartenders mix drinks and serve them directly to customers or through wait staff.
view profile » - Food and Beverage Serving and Related Workers
Food and Beverage Serving and Related Workers
Food and beverage serving and related workers perform a variety of customer service, food preparation, and cleaning duties in restaurants, cafeterias, and other eating and drinking establishments.
view profile » - Waiters and Waitresses
Waiters and Waitresses
Waiters and waitresses take orders and serve food and beverages to customers in dining establishments.
view profile » - Janitors and Building Cleaners
Janitors and Building Cleaners
Janitors and building cleaners keep many types of buildings clean, orderly, and in good condition.
view profile » - Pest Control Workers
Pest Control Workers
Pest control workers remove unwanted pests, such as roaches, rats, ants, bedbugs, mosquitoes, ticks and termites that infest buildings and surrounding areas.
view profile » - Grounds Maintenance Workers
Grounds Maintenance Workers
Grounds maintenance workers ensure that the grounds of houses, businesses, and parks are attractive, orderly, and healthy in order to provide a pleasant outdoor environment.
view profile » - Animal Care and Service Workers
Animal Care and Service Workers
Animal care and service workers attend to animals. They feed, groom, bathe, and exercise pets and other nonfarm animals.
view profile » - Gaming Services Workers
Gaming Services Workers
Gaming services workers serve customers in gambling establishments, such as casinos or racetracks. Some workers tend slot machines, deal cards, or oversee other gaming activities such as keno or bingo. Others take bets or pay out winnings. Still others supervise or manage gaming workers and operations.
view profile » - Barbers, Hairstylists, and Cosmetologists
Barbers, Hairstylists, and Cosmetologists
Barbers, hairstylists, and cosmetologists provide haircutting, hairstyling, and a range of other beauty services.
view profile » - Manicurists and Pedicurists
Manicurists and Pedicurists
Manicurists and pedicurists clean, shape, and beautify fingernails and toenails.
view profile » - Skincare Specialists
Skincare Specialists
Skincare specialists cleanse and beautify the face and body to enhance a person’s appearance.
view profile » - Flight Attendants
Flight Attendants
Flight attendants provide routine services and respond to emergencies to ensure the safety and comfort of airline passengers while aboard planes.
view profile » - Childcare Workers
Childcare Workers
Childcare workers attend to the basic needs of children, such as dressing, bathing, feeding, and overseeing play. They may help younger children prepare for kindergarten or assist older children with homework.
view profile » - Fitness Trainers and Instructors
Fitness Trainers and Instructors
Fitness trainers and instructors lead, instruct, and motivate individuals or groups in exercise activities, including cardiovascular exercises (exercises for the heart and blood circulation), strength training, and stretching. They work with people of all ages and skill levels.
view profile » - Recreation Workers
Recreation Workers
Recreation workers design and lead activities to help people stay active, improve fitness, and have fun. They work with groups in summer camps, fitness and recreational sports centers, nursing care facilities, nature parks, and other settings. They may lead such activities as arts and crafts, sports, music, dramatics, or games.
view profile » - Cashiers
Cashiers
Cashiers process payments from customers purchasing goods and services.
view profile » - Retail Sales Workers
Retail Sales Workers
Retail sales workers help customers find products they want and process customers’ payments. There are two types of retail sales workers: retail salespersons, who sell retail merchandise, such as clothing, furniture, and automobiles; and parts salespersons, who sell spare and replacement parts and equipment, especially car parts.
view profile » - Advertising Sales Agents
Advertising Sales Agents
Advertising sales agents sell advertising space to businesses and individuals. They contact potential clients, make sales presentations, and maintain client accounts.
view profile » - Insurance Sales Agents
Insurance Sales Agents
Insurance sales agents contact potential customers and sell one or more types of insurance. Insurance sales agents explain various insurance policies and help clients choose plans that suit them.
view profile » - Wholesale and Manufacturing Sales Representatives
Wholesale and Manufacturing Sales Representatives
Wholesale and manufacturing sales representatives sell goods for wholesalers or manufacturers to businesses, government agencies, and other organizations. They contact customers, explain the features of the products they are selling, negotiate prices, and answer any questions that their customers may have about the products.
view profile » - Models
Models
Models pose for artists, customers, or photographers to help advertise a variety of products, including clothing, cosmetics, food, and appliances.
view profile » - Real Estate Brokers and Sales Agents
Real Estate Brokers and Sales Agents
Real estate brokers and sales agents help clients buy, sell, and rent properties. Although brokers and agents do similar work, brokers are licensed to manage their own real estate businesses. Sales agents must work with a real estate broker.
view profile » - Sales Engineers
Sales Engineers
Sales engineers sell complex scientific and technological products or services to businesses. They must have extensive knowledge of the products’ parts and functions and must understand the scientific processes that make these products work.
view profile » - Bill and Account Collectors
Bill and Account Collectors
Bill and account collectors try to recover payment on overdue bills. They negotiate repayment plans with debtors and help them find solutions to make paying their overdue bills easier.
view profile » - Bookkeeping, Accounting, and Auditing Clerks
Bookkeeping, Accounting, and Auditing Clerks
Bookkeeping, accounting, and auditing clerks produce financial records for organizations. They record financial transactions, update statements, and check financial records for accuracy.
view profile » - Tellers
Tellers
Tellers are responsible for accurately processing routine transactions at a bank. These transactions include cashing checks, depositing money, and collecting loan payments.
view profile » - Customer Service Representatives
Customer Service Representatives
Customer service representatives interact with customers to handle complaints, process orders, and provide information about an organization’s products and services.
view profile » - Receptionists
Receptionists
Receptionists perform administrative tasks, such as answering phones, receiving visitors, and providing general information about their organization to the public and customers.
view profile » Police, Fire, and Ambulance Dispatchers
Police, fire, and ambulance dispatchers, also called public safety telecommunicators, answer emergency and nonemergency calls.
view profile »Postal Service Workers
Postal service workers sell postal products and collect, sort, and deliver mail.
view profile »Secretaries and Administrative Assistants
Secretaries and administrative assistants perform routine clerical and administrative duties. They organize files, prepare documents, schedule appointments, and support other staff.
view profile »Desktop Publishers
Desktop publishers use computer software to design page layouts for newspapers, books, brochures, and other items that are printed or published online.
view profile »Agricultural Workers
Agricultural workers maintain crops and tend to livestock. They perform physical labor and operate machinery under the supervision of farmers, ranchers, and other agricultural managers.
view profile »Fishing and Hunting Workers
Fishing and hunting workers catch and trap various types of animal life. The fish and wild animals they catch are for human food, animal feed, bait, and other uses.
view profile »Masonry Workers
Masonry workers, also known as masons, use bricks, concrete blocks, concrete, and natural and manmade stones to build walls, walkways, fences, and other masonry structures.
view profile »Carpenters
Carpenters construct, repair, and install building frameworks and structures made from wood and other materials.
view profile »Flooring Installers and Tile and Marble Setters
Flooring installers and tile and marble setters lay and finish carpet, wood, vinyl, and tile.
view profile »Construction Laborers and Helpers
Construction laborers and helpers perform many tasks that require physical labor on construction sites.
view profile »Construction Equipment Operators
Construction equipment operators drive, maneuver, or control the heavy machinery used to construct roads, bridges, buildings, and other structures.
view profile »Drywall and Ceiling Tile Installers, and Tapers
Drywall and ceiling tile installers hang wallboard and install ceiling tile inside buildings. Tapers prepare the wallboard for painting, using tape and other materials. Many workers both install and tape wallboard.
view profile »Glaziers
Glaziers install glass in windows, skylights, and other fixtures in storefronts and buildings.
view profile »Construction and Maintenance Painters
Painters apply paint, stain, and coatings to walls and ceilings, buildings, bridges, and other structures.
view profile »Plumbers, Pipefitters, and Steamfitters
Plumbers, pipefitters, and steamfitters install and repair pipes that carry liquids or gases to, from, and within businesses, homes, and factories.
view profile »Roofers
Roofers replace, repair, and install the roofs of buildings, using a variety of materials, including shingles, bitumen, and metal.
view profile »Ironworkers
Ironworkers install structural and reinforcing iron and steel to form and support buildings, bridges, and roads.
view profile »Construction and Building Inspectors
Construction and building inspectors ensure that construction meets local and national building codes and ordinances, zoning regulations, and contract specifications.
view profile »Elevator Installers and Repairers
Elevator installers and repairers install, fix, and maintain elevators, escalators, moving walkways, and other lifts.
view profile »Hazardous Materials Removal Workers
Hazardous materials (hazmat) removal workers identify and dispose of asbestos, lead, radioactive waste, and other hazardous materials. They also neutralize and clean up materials that are flammable, corrosive, or toxic.
view profile »Automotive Body and Glass Repairers
Automotive body and glass repairers restore, refinish, and replace vehicle bodies and frames, windshields, and window glass.
view profile »Automotive Service Technicians and Mechanics
Automotive service technicians and mechanics, often called service technicians or service techs, inspect, maintain, and repair cars and light trucks.
view profile »Diesel Service Technicians and Mechanics
Diesel service technicians (also known as diesel technicians) and mechanics inspect, repair, and overhaul buses and trucks, or maintain and repair any type of diesel engine.
view profile »Small Engine Mechanics
Small engine mechanics inspect, service, and repair motorized power equipment. Mechanics often specialize in one type of equipment, such as motorcycles, motorboats, or outdoor power equipment.
view profile »General Maintenance and Repair Workers
General maintenance and repair workers fix and maintain machines, mechanical equipment, and buildings. They paint, repair flooring, and work on plumbing, electrical, and air-conditioning and heating systems, among other tasks.
view profile »Line Installers and Repairers
Line installers and repairers, also known as line workers, install or repair electrical power systems and telecommunications cables, including fiber optics.
view profile »Medical Equipment Repairers
Medical equipment repairers install, maintain, and repair patient care equipment.
view profile »Assemblers and Fabricators
Assemblers and fabricators assemble finished products and the parts that go into them. They use tools, machines, and their hands to make engines, computers, aircraft, ships, boats, toys, electronic devices, control panels, and more.
view profile »Bakers
Bakers mix ingredients according to recipes in order to make breads, pastries, and other baked goods.
view profile »Metal and Plastic Machine Workers
Metal and plastic machine workers set up and operate machines that cut, shape, and form metal and plastic materials or pieces.
view profile »Machinists and Tool and Die Makers
Machinists and tool and die makers set up and operate a variety of computer-controlled and mechanically controlled machine tools to produce precision metal parts, instruments, and tools.
view profile »Welders, Cutters, Solderers, and Brazers
Welders, cutters, solderers, and brazers use hand-held or remotely controlled equipment to join or cut metal parts. They also fill holes, indentations, or seams in metal products.
view profile »Woodworkers
Woodworkers manufacture a variety of products such as cabinets and furniture, using wood, veneers, and laminates. They often combine and incorporate different materials into wood.
view profile »Stationary Engineers and Boiler Operators
Stationary engineers and boiler operators control stationary engines, boilers, or other mechanical equipment to provide utilities for buildings or for industrial purposes.
view profile »Quality Control Inspectors
Quality control inspectors examine products and materials for defects or deviations from specifications.
view profile »Jewelers and Precious Stone and Metal Workers
Jewelers and precious stone and metal workers design, construct, adjust, repair, appraise and sell jewelry.
view profile »- Dental and Ophthalmic Laboratory Technicians and Medical Appliance Technicians
Dental and Ophthalmic Laboratory Technicians and Medical Appliance Technicians
Dental and ophthalmic laboratory technicians and medical appliance technicians construct, fit, or repair medical appliances and devices, including dentures, eyeglasses, and prosthetics.
view profile » - Airline and Commercial Pilots
Airline and Commercial Pilots
Airline and commercial pilots fly and navigate airplanes, helicopters, and other aircraft.
view profile » - Air Traffic Controllers
Air Traffic Controllers
Air traffic controllers coordinate the movement of aircraft to maintain safe distances between them.
view profile » - Bus Drivers
Bus Drivers
Bus drivers transport people between various places—including work, school, and shopping centers—and across state or national borders. Some drive regular routes, and others transport passengers on chartered trips or sightseeing tours.
view profile » - Heavy and Tractor-trailer Truck Drivers
Heavy and Tractor-trailer Truck Drivers
Heavy and tractor-trailer truck drivers transport goods from one location to another. Most tractor-trailer drivers are long-haul drivers and operate trucks with a gross vehicle weight (GVW) capacity—that is, the combined weight of the vehicle, passengers, and cargo—exceeding 26,000 pounds. These drivers deliver goods over intercity routes, sometimes spanning several states.
view profile » - Taxi Drivers, Ride-Hailing Drivers, and Chauffeurs
Taxi Drivers, Ride-Hailing Drivers, and Chauffeurs
Taxi drivers, ride-hailing drivers, and chauffeurs transport people to and from the places they need to go, such as airports, homes, shopping centers, and workplaces. These drivers must know their way around a city to take passengers to their destinations.
view profile » - Railroad Workers
Railroad Workers
Workers in railroad occupations ensure that passenger and freight trains run on time and travel safely. Some workers drive trains, some coordinate the activities of the trains, and others operate signals and switches in the rail yard.
view profile » - Water Transportation Workers
Water Transportation Workers
Water transportation workers operate and maintain vessels that take cargo and people over water. The vessels travel to and from foreign ports across the ocean and to domestic ports along the coasts, across the Great Lakes, and along the country’s many inland waterways.
view profile » - Material Moving Machine Operators
Material Moving Machine Operators
Material moving machine operators use machinery to transport various objects. Some operators move construction materials around building sites or excavate earth from a mine. Others move goods around a warehouse or onto container ships.
view profile » - Hand Laborers and Material Movers
Hand Laborers and Material Movers
Hand laborers and material movers manually move freight, stock, or other materials. Some of these workers may feed or remove material to and from machines, clean vehicles, pick up unwanted household goods, and pack materials for moving.
view profile » - Purchasing Managers, Buyers, and Purchasing Agents
Purchasing Managers, Buyers, and Purchasing Agents
Buyers and purchasing agents buy products and services for organizations to use or resell. Purchasing managers oversee the work of buyers and purchasing agents.
view profile » - Logisticians
Logisticians
Logisticians analyze and coordinate an organization’s supply chain—the system that moves a product from supplier to consumer. They manage the entire life cycle of a product, which includes how a product is acquired, allocated, and delivered.
view profile » - Agricultural Engineers
Agricultural Engineers
Agricultural engineers attempt to solve agricultural problems concerning power supplies, the efficiency of machinery, the use of structures and facilities, pollution and environmental issues, and the storage and processing of agricultural products.
view profile » - Health and Safety Engineers
Health and Safety Engineers
Health and safety engineers develop procedures and design systems to protect people from illness and injury and property from damage. They combine knowledge of engineering and of health and safety to make sure that chemicals, machinery, software, furniture, and other products will not cause harm to people or damage to property.
view profile » - Aerospace Engineering and Operations Technicians
Aerospace Engineering and Operations Technicians
Aerospace engineering and operations technicians operate and maintain equipment used in developing, testing, producing, and sustaining new aircraft and spacecraft. Increasingly, these workers are using computer-based modeling and simulation tools and processes in their work, as well as advanced automation and robotics.
view profile » - Electrical and Electronics Engineering Technicians
Electrical and Electronics Engineering Technicians
Electrical and electronics engineering technicians help engineers design and develop computers, communications equipment, medical monitoring devices, navigational equipment, and other electrical and electronic equipment. They often work in product evaluation and testing, and use measuring and diagnostic devices to adjust, test, and repair equipment. They are also involved in the manufacture and deployment of equipment for automation.
view profile » - Electro-mechanical Technicians
Electro-mechanical Technicians
Electro-mechanical technicians combine knowledge of mechanical technology with knowledge of electrical and electronic circuits. They operate, test, and maintain unmanned, automated, robotic, or electromechanical equipment.
view profile » - Conservation Scientists and Foresters
Conservation Scientists and Foresters
Conservation scientists and foresters manage the overall land quality of forests, parks, rangelands, and other natural resources.
view profile » - Geographers
Geographers
Geographers study the Earth and the distribution of its land, features, and inhabitants. They also examine political or cultural structures and study the physical and human geographic characteristics of regions ranging in scale from local to global.
view profile » - Historians
Historians
Historians research, analyze, interpret, and write about the past by studying historical documents and sources.
view profile » - Agricultural and Food Science Technicians
Agricultural and Food Science Technicians
Agricultural and food science technicians assist agricultural and food scientists by performing duties such as measuring and analyzing the quality of food and agricultural products.
view profile » - Craft and Fine Artists
Craft and Fine Artists
Craft and fine artists use a variety of materials and techniques to create art for sale and exhibition. Craft artists create handmade objects, such as pottery, glassware, textiles, and other objects that are designed to be functional. Fine artists, including painters, sculptors, and illustrators, create original works of art for their aesthetic value, rather than for a functional one.
view profile » - Orthotists and Prosthetists
Orthotists and Prosthetists
Orthotists and prosthetists design and fabricate medical supportive devices and measure and fit patients for them. These devices include artificial limbs (arms, hands, legs, and feet), braces, and other medical or surgical devices.
view profile » - Fire Inspectors
Fire Inspectors
Fire inspectors examine buildings in order to detect fire hazards and ensure that federal, state, and local fire codes are met. Fire investigators, another type of worker in this field, determine the origin and cause of fires and explosions. Forest fire inspectors and prevention specialists assess outdoor fire hazards in public and residential areas.
view profile » - Financial Clerks
Financial Clerks
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A-Z INDEX
BROWSE OCCUPATIONS
BROWSE RESOURCES
| Defibrillation | |
|---|---|
View of defibrillator electrode position and placement. |
Defibrillation is a treatment for life-threatening cardiac dysrhythmias, specifically ventricular fibrillation (VF) and non-perfusing ventricular tachycardia (VT).[1][2] A defibrillator delivers a dose of electric current (often called a countershock) to the heart. Although not fully understood, this would depolarize a large amount of the heart muscle, ending the dysrhythmia. Subsequently, the body's natural pacemaker in the sinoatrial node of the heart is able to re-establish normal sinus rhythm.[3]
In contrast to defibrillation, synchronized electrical cardioversion is an electrical shock delivered in synchrony to the cardiac cycle. Although the person may still be critically ill, cardioversion normally aims to end poorly perfusing cardiac dysrhythmias, such as supraventricular tachycardia.[1][2]
Defibrillators can be external, transvenous, or implanted (implantable cardioverter-defibrillator), depending on the type of device used or needed.[4] 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 no training.[2]
- 2Types
- 3Interface with person
- 5History
- 6Society and culture
Medical uses[edit]
Defibrillation is often an important step in cardiopulmonary resuscitation (CPR).[5][6] CPR is an algorithm-based intervention aimed to restore cardiac and pulmonary function.[5] Defibrillation is indicated only in certain types of cardiac dysrhythmias, specifically ventricular fibrillation (VF) and pulseless ventricular tachycardia.[1][2] If the heart has completely stopped, as in asystole or pulseless electrical activity (PEA), defibrillation is not indicated. Defibrillation is also not indicated if the patient is conscious or has a pulse. Improperly given electrical shocks can cause dangerous dysrhythmias, such as ventricular fibrillation.[1]
Survival rates for out-of-hospital cardiac arrests are poor, often less than 10%.[7] Outcome for in-hospital cardiac arrests are higher at 20%.[7] Within the group of people presenting with cardiac arrest, the specific cardiac rhythm can significantly impact survival rates. Compared to people presenting with a non-shockable rhythm (such as asystole or PEA), people with a shockable rhythm (such as VF or pulseless ventricular tachycardia) have improved survival rates, ranging between 21-50%.[5][8][9]
Types[edit]
Manual external defibrillator[edit]
Manual external defibrillators require the expertise of a healthcare professional.[10][11] They are used in conjunction with an electrocardiogram, which can be separate or built-in. A healthcare provider first diagnose the cardiac rhythm and then manually determine the voltage and timing for the electrical shock. These units are primarily found in hospitals and on some ambulances. For instance, every NHS ambulance in the United Kingdom is equipped with a manual defibrillator for use by the attending paramedics and technicians.[citation needed] In the United States, many advanced EMTs and all paramedics are trained to recognize lethal arrhythmias and deliver appropriate electrical therapy with a manual defibrillator when appropriate.[citation needed]
Manual internal defibrillator[edit]
Manual internal defibrillators delivers the shock through paddles placed directly on the heart.[1] They are mostly used in the operating room and, in rare circumstances, in the emergency room during an open heart procedure.
Automated external defibrillator (AED)[edit]
Automated external defibrillators are designed for use by untrained or briefly trained laypersons.[12][13][14] AEDs contain technology for analysis of heart rhythms. As a result, it does not require a trained health provider to determine whether or not a rhythm is shockable. By making these units publicly available, AEDs have improved outcomes for sudden out-of-hospital cardiac arrests.[12][13]
Trained health professionals have more limited use for AEDs than manual external defibrillators.[15] Recent studies show that AEDs does not improve outcome in patients with in-hospital cardiac arrests.[15][16] AEDs have set voltages and does not allow the operator to vary voltage according need. AEDs may also delay delivery of effective CPR. For diagnosis of rhythm, AEDs often require the stopping of chest compressions and rescue breathing. For these reasons, certain bodies, such as the European Resuscitation Council, recommend using manual external defibrillators over AEDs if manual external defibrillators are readily available.[16]
As early defibrillation can significantly improve VF outcomes, AEDs have become publicly available in many easily accessible areas.[15][16] AEDs have been incorporated into the algorithm for basic life support (BLS). Many first responders, such as firefighters, policemen, and security guards, are equipped with them.
AEDs can be fully automatic or semi-automatic.[17] A semi-automatic AED automatically diagnoses heart rhythms and determines if a shock is necessary. If a shock is advised, the user must then push a button to administer the shock. A fully automated AED automatically diagnoses the heart rhythm and advises the user to stand back while the shock is automatically given. Some types of AEDs come with advanced features, such as a manual override or an ECG display.
Implantable cardioverter-defibrillator[edit]
Also known as automatic internal cardiac defibrillator (AICD). These devices are implants, similar to pacemakers (and many can also perform the pacemaking function). 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. 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. 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). If the device is shocking frequently, but appropriately, EMS personnel may administer sedation.
Wearable cardioverter defibrillator[edit]
A wearable cardioverter defibrillator is a portable external defibrillator that can be worn by at-risk patients.[18] The unit monitors the patient 24 hours a day and can automatically deliver a biphasic shock if VF or VT is detected. This device is mainly indicated in patients who are not immediate candidates for ICDs.[19]
Internal defibrillator[edit]
This is often used to defibrillate the heart during or after cardiac surgery such as a heart bypass. The electrodes consist of round metal plates that come in direct contact with the myocardium.
Interface with person[edit]
The connection between the defibrillator and the patient consists of a pair of electrodes, each provided with electrically conductive gel in order to ensure a good connection and to minimize electrical resistance, also called chest impedance (despite the DC discharge) which would burn the patient. Gel may be either wet (similar in consistency to surgical lubricant) or solid (similar to gummi candy). Solid-gel is more convenient, because there is no need to clean the used gel off the person's skin after defibrillation. However, the use of solid-gel presents a higher risk of burns during defibrillation, since wet-gel electrodes more evenly conduct electricity into the body. Paddle electrodes, which were the first type developed, come without gel, and must have the gel applied in a separate step. Self-adhesive electrodes come prefitted with gel. There is a general division of opinion over which type of electrode is superior in hospital settings; the American Heart Association favors neither, and all modern manual defibrillators used in hospitals allow for swift switching between self-adhesive pads and traditional paddles. Each type of electrode has its merits and demerits.
Paddle electrodes[edit]
The most well-known type of electrode (widely depicted in films and television) is the traditional metal paddle with an insulated (usually plastic) handle. This type must be held in place on the patient's skin with approximately 25 lbs of force while a shock or a series of shocks is delivered. Paddles offer a few advantages over self-adhesive pads. Many hospitals in the United States continue the use of paddles, with disposable gel pads attached in most cases, due to the inherent speed with which these electrodes can be placed and used. This is critical during cardiac arrest, as each second of nonperfusion means tissue loss. Modern paddles allow for monitoring (electrocardiography), though in hospital situations, separate monitoring leads are often already in place.
Paddles are reusable, being cleaned after use and stored for the next patient. Gel is therefore not preapplied, and must be added before these paddles are used on the patient. Paddles are generally only found on manual external units.
Self-adhesive electrodes[edit]
Newer types of resuscitation electrodes are designed as an adhesive pad, which includes either solid or wet gel. These are peeled off their backing and applied to the patient's chest when deemed necessary, much the same as any other sticker. The electrodes are then connected to a defibrillator, much as the paddles would be. If defibrillation is required, the machine is charged, and the shock is delivered, without any need to apply any additional gel or to retrieve and place any paddles. Most adhesive electrodes are designed to be used not only for defibrillation, but also for transcutaneous pacing and synchronized electrical cardioversion. These adhesive pads are found on most automated and semi-automated units and are replacing paddles entirely in non-hospital settings. In hospital, for cases where cardiac arrest is likely to occur (but has not yet), self-adhesive pads may be placed prophylactically.
Pads also offer an advantage to the untrained user, and to medics working in the sub-optimal conditions of the field. Pads do not require extra leads to be attached for monitoring, and they do not require any force to be applied as the shock is delivered. Thus, adhesive electrodes 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 be up to several feet away. (The risk of electrical shock to others remains unchanged, as does that of shock due to operator misuse.) Self-adhesive electrodes are single-use only. They may be used for multiple shocks in a single course of treatment, but are replaced if (or in case) the patient recovers then reenters cardiac arrest.
Placement[edit]
Resuscitation electrodes are placed according to one of two schemes. The anterior-posterior scheme 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.
Researchers have created a software modeling system capable of mapping an individual's chest and determining the best position for an external or internal cardiac defibrillator.[20]
Mechanism of action[edit]
The exact mechanism of defibrillation is not well understood.[2][21] One theory is that successful defibrillation affects a critical mass of the heart, resulting in insufficient remaining heart muscle to continue the arrhythmia.[2] Recent mathematical models of defibrillation are providing new insight into how cardiac tissue responds to a strong electrical shock.[21]
History[edit]
Bls For Healthcare Providers Student Manual Free Download For Windows 10
Defibrillators were first demonstrated in 1899 by Jean-Louis Prévost and Frédéric Batelli, two physiologists from University of Geneva, Switzerland. They discovered that small electrical shocks could induce ventricular fibrillation in dogs, and that larger charges would reverse the condition.[22][23]
In 1933, Dr. Albert Hyman, heart specialist at the Beth Davis Hospital of New York City and C. Henry Hyman, an electrical engineer, looking for an alternative to injecting powerful drugs directly into the heart, came up with an invention that used an electrical shock in place of drug injection. This invention was called the Hyman Otor where a hollow needle is used to pass an insulated wire to the heart area to deliver the electrical shock. The hollow steel needle acted as one end of the circuit and the tip of the insulated wire the other end. Whether the Hyman Otor was a success is unknown.[24]
The external defibrillator as known today was invented by Electrical Engineer William Kouwenhoven in 1930. William studied the relation between the electric shocks and its effects on human heart when he was a student at Johns Hopkins University School of Engineering. His studies helped him to invent a device for external jump start of the heart. He invented the defibrillator and tested on a dog, like Prévost and Batelli.The first use on a human was in 1947 by Claude Beck,[25] 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 'Hearts that are 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 on either side of the heart, along with procainamide, an antiarrhythmic drug, and achieved return of normal sinus rhythm.[citation needed]
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.[citation needed]
Closed-chest method[edit]
Until the early 1950s, defibrillation of the heart was possible only when the chest cavity was open during surgery. The technique used an alternating voltage from a 300 or greater volt source derived from standard AC power, 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. The closed-chest defibrillator device which applied an alternating voltage 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 (today known as Bishkek, Kyrgyzstan) in the mid-1950s.[26] The duration of AC shocks was typically in the range of 100-150 milliseconds[27]
Direct current method[edit]
Early successful experiments of successful defibrillation by the discharge of a capacitor performed on animals were reported by N. L. Gurvich and G. S. Yunyev in 1939.[28] In 1947 their works were reported in western medical journals.[29] Serial production of Gurvich's pulse defibrillator started in 1952 at the electromechanical plant of the institute, and was designated model ИД-1-ВЭИ (Импульсный Дефибриллятор 1, Всесоюзный Электротехнический Институт, or in English, Pulse Defibrillator 1, All-Union Electrotechnical Institute). It is described in detail in Gurvich's 1957 book, Heart Fibrillation and Defibrillation.[30]
The first Czechoslovak 'universal defibrillator Prema' was manufactured in 1957 by the company Prema, designed by dr. Bohumil Peleška. In 1958 his device was awarded Grand Prix at Expo 58.[31]
In 1958, US senator Hubert H. Humphrey visited Nikita Khrushchev and among other things he visited the Moscow Institute of Reanimatology, where, among others, he met with Gurvich.[32] Humphrey immediately recognized importance of reanimation research and after that a number of American doctors visited Gurvich. At the same time, Humphrey worked on establishing of a federal program in the National Institute of Health in physiology and medicine, telling to the Congress: 'Let's compete with U.S.S.R. in research on reversibility of death'.[33]
In 1959 Bernard Lown commenced research in his animal laboratory in collaboration with engineer Barouh Berkovits into a 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. This team further developed an understanding of the optimal timing of shock delivery in the cardiac cycle, enabling the application of the device to arrhythmias such as atrial fibrillation, atrial flutter, and supraventricular tachycardias in the technique known as 'cardioversion'.
The Lown-Berkovits waveform, as it was known, was the standard for defibrillation until the late 1980s. Earlier in the 1980s, the 'MU lab' at the University of Missouri had pioneered numerous studies introducing a new waveform called a biphasic truncated waveform (BTE). In this waveform an exponentially decaying DC voltage is reversed in polarity about halfway through the shock time, then continues to decay for some time after which the voltage is cut off, or truncated. The studies showed that the biphasic truncated waveform could be more efficacious while requiring the delivery of lower levels of energy to produce defibrillation.[27] An added benefit 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[citation needed].
Portable units become available[edit]
A major breakthrough was the introduction of portable defibrillators used out of the hospital. Already Peleška's Prema defibrillator was designed to be more portable than original Gurvich's model. In Soviet Union, a portable version of Gurvich's defibrillator, model ДПА-3 (DPA-3), was reported in 1959.[34] In the west this was pioneered in the early 1960s by Prof. Frank Pantridge in Belfast. Today portable defibrillators are among the many very important tools carried by ambulances. They are the only proven way to resuscitate a person who has had a cardiac arrest unwitnessed by Emergency Medical Services (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, partly based on the work developing implanted versions (see below), have led to the availability of Automated External Defibrillators. These devices can analyse the heart rhythm by themselves, diagnose the shockable rhythms, and charge 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[edit]
Until the mid 90s, external defibrillators delivered a Lown type waveform (see Bernard Lown) which was a heavily damped sinusoidal impulse having a mainly uniphasic characteristic.Biphasic defibrillation alternates the direction of the pulses, completing one cycle in approximately 12 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, decreasing the 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. Most biphasic defibrillators have a first shock success rate of greater than 90%.[35]
Implantable devices[edit]
A further development in defibrillation came with the invention of the implantable device, known as an implantable cardioverter-defibrillator (or ICD). This was pioneered at Sinai Hospital in Baltimore by a team that included Stephen Heilman, Alois Langer, Jack Lattuca, Morton Mower, Michel Mirowski, and Mir Imran, with the help of industrial collaborator Intec Systems of Pittsburgh.[36] 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 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 1962 Bernard Lown introduced the external DC defibrillator. This device applied a direct current from a discharging capacitor through the chest wall into the heart to stop heart fibrillation.[37]In 1972, Lown 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. In fact, the implanted defibrillator system represents an imperfect solution in search of a plausible and practical application.'[38]
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. Levi Watkins, Jr. assisted by Vivien Thomas. Modern ICDs do not require a thoracotomy and possess pacing, cardioversion, and defibrillation capabilities.
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.
People can live long normal lives with the devices. Many patients have multiple implants. A patient in Houston, Texas had an implant at the age of 18 in 1994 by the recent Dr. Antonio Pacifico. He was awarded 'Youngest Patient with Defibrillator' in 1996. Though today these devices are implanted into small babies shortly after birth.
Society and culture[edit]
As devices that can quickly produce dramatic improvements in patient health, defibrillators are often depicted in movies, television, video games and other fictional media. Their function, however, is often exaggerated, with the defibrillator inducing a sudden, violent jerk or convulsion by the patient; in reality, although the muscles may contract, such dramatic patient presentation is rare. Similarly, medical providers are often depicted defibrillating patients with a 'flat-line' ECG rhythm (also known as asystole). This is not normal medical practice, as the heart cannot be restarted by the defibrillator itself. Only the cardiac arrest rhythms ventricular fibrillation and pulseless ventricular tachycardia are normally defibrillated. The purpose of defibrillation is to depolarize the entire heart all at once so that it is synchronized, in the hope that it will resume beating normally. Someone who is already in asystole cannot be helped by electrical means, and usually needs urgent CPR and intravenous medication. There are also several heart rhythms that can be 'shocked' when the patient is not in cardiac arrest, such as supraventricular tachycardia and ventricular tachycardia that produces a pulse; this more-complicated procedure is known as cardioversion, not defibrillation.
Trivia[edit]
In Australia up until the 1990s it was relatively rare for ambulances to carry defibrillators. This changed in 1990 after Australian media mogulKerry Packer had a heart attack and, purely by chance, the ambulance that responded to the call carried a defibrillator. After recovering, 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, which is why defibrillators in Australia are sometimes colloquially called 'Packer Whackers'.[39] Following the widespread introduction of the machines to Ambulances, various Governments have distributed them to local sporting fields.
See also[edit]
- Advanced cardiac life support (ACLS)
- Cardiopulmonary resuscitation (CPR)
- Myocardial infarction (heart attack)
References[edit]
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Bibliography[edit]
- Picard, André (2007-04-27). 'School defibrillators could be a lifesaver'. The Globe and Mail. Retrieved 2015-07-23.
External links[edit]
| Wikimedia Commons has media related to Defibrillator. |
- How an internal defibrillator is implanted from Children's Hospital Heart Center, Seattle.