what is ECT
- ECT is also known as electroshock therapy.
- ECT is a physical therapy in which artificial or grand mal seizure is produced in patients by applying the electrode on the temporal region between the hemispheres of the brain.
- ECT is the main and most common treatment for severe depression patients.
History of ECT
- ECT was introduced by the cerletti and Bini in 1938.
- American psychiatric association provides rights for ECT.
- In 1976, consent started before ECT.
- Consent for ECT should be collected by the patient.
- In 2005, WHO also recommended consent before ECT.
- In 2010, the Parliament of India passed the act to collect consent before ECT.
Indication of ECT
- Major Severe depression of suicidal ideas.
- Schizophrenia types – catatonic schizophrenia
- Paranoid schizophrenia
- Unresponsive schizophrenia.
- Bipolar disorder.
- Organic brain syndrome.
- Delirium and profound mania.
- Medical condition seizures.
Contraindication of ECT
- Pregnancy, fracture patient.
- Old age patient.
- Myocardial infarction patient.
- Retinal detachment.
- Brain tumor.
- Increased ICP (1st priority option).
- Renal and lungs disorder.
- Note – ECT is contraindicated in pregnancy only in 1st trimester.
Amount of current in ECT
- 70 – 130 volt.
- If seizures are not produced or patients take lithium therapy, it can be extended up to 150 volt.
- Time duration of ECT = 0.6 – 1 second.
- Extended up to 1.2 seconds.
Method and techniques of ECT
Direct method –
- The direct method applies without sedation or anesthesia.
- Only use the atropine sulfate.
- Indirect method –
- the indirect method also known as – modified ECT.
- The indirect method is the commonest in clinical practice.
- Anesthesia and sedation used during ECT with other associated drugs are –
- Atropine sulfate
- Thiopentane sodium
- O2 inhalation.
Drugs during ECT
- Atropine sulfate – Administer 30 minutes from ECT.
- Atropine sulfate is used in ECT to prevent bradycardia.
- Thiopentone sodium – Thiopentane sodium used to provide the anaesthesia during ECT.
- Control the intensity of seizure.
- Succinylcholine – Used as a muscle relaxant.
- During ECT succinylcholine prevents the risk of fracture.
Learning trick for – sequence of drug administration during ECT
आज तुम सब को हवा में उड़ा दूँगा ।
आज = atropine sulfate
तुम = thiopentone sodium
सबको = succinylcholine
हवा = O2 administer.
Types of ECT
Unilateral ECT –
- In unilateral ECT, electrodes are placed on a single side.
Eg. – Right side is for a right-handed person and the left side for a left-handed person.
- Unilateral ECT is less effective and less confusing and less complicated.
Bilateral ECT –
- Bilateral ECT is most commonly used in clinical practice.
- Electrodes are placed on both sides of the temporal region.
- Side of bilateral ECT – Bi frontal
- Bi temporal region
- Bilateral ECT is most effective but more confusing or more complicated.
Note – Position, where electrodes are placed unilateral.
ECT = D-Elias position.
Frequency of ECT –
In depression = Total ECT is 6 – 8 times.
In schizophrenia = Total ECT is 8 – 12 times.
In chronic schizophrenia = Total ECT 20 – 25 times.
Note – 3 times alternative days in a week.
(Only 3 ECT in a week)
Nursing role in preparation ECT
- Nurses collect lab investigations and reports. Eg. – X-ray, ECG, and blood reports.
- Select the consent of the patient.
- Physical examination of the patient before the ECT.
- The empty bowel and bladder of the patient are done.
- Inform the family member of the procedure.
- Remove all artificial dentures, metallic jewelry, and articles of lipstick and nail paints.
- Loose cloth provided to patients.
- Vital sign examination.
- Shampoo to the hair, tie to the women’s hair.
- A nurse administered pre- ECT medication.
Nursing role during ECT
- Nurses provide the supine position and apply pillows under the lumbar curve to prevent the risk of fracture in the 3rd, 4th, and 5th lumbar vertebra.
- Anaesthetic medication is to be administered.
- Restrain both legs, to prevent the risk of femur fracture.
- Provide mouth gag to prevent tongue bites.
- Hyperextension of the head with support to the chin is to be done.
- Vital sign examination and maintaining an airway.
- Observe tonic and clonic phases during ECT.
- Observe the intensity of seizures.
Nursing role after ECT
- A nurse opened the restrain.
- Place the patient in a lateral or side-lying position.
- Assess the vital sign.
- Nurses physically observe the patient for injury or any complications.
- Give a sip of water to check the gag reflex.
- Ambulation to the patient to observe the injury of fracture.
Complications of ECT
- Retrograde amnesia – unable to recall past memory.
- Most common complication.
- Respiratory distress.
- Mandible/jaw fracture (most common fracture after ECT).
- Which type of therapy is used in the ECT – Physical Therapy?
- Electroshock therapy was introduced by – Carletti and Bini in 1938.
- WHO recommended consent before ECT – in 2005.
- ECT Consent was taken from the – Patient.
- ECT Consent act was passed by the Parliament of India in – 2010.
- ECT is the most effective management in which disease conditions – Severe depression and suicidal ideas.
- Which type of Schizophrenia where ECT is less effective – Paranoid Schizophrenia.
- Which type of Schizophrenia, where ECT is more effective – Catatonic Schizophrenia.
- what is ect power?- 70 – 130 volt.
- The most common ECT method used in clinical practice? – indirect Method.
- Another name for indirect ECT methods? – Modified ECT.
- Which drug to use to prevent bradycardia in ECT? – Atropine Sulphate.
- Which drug can cause respiratory problems during ECT? – Succinylcholine.
- The most common type of ECT in clinical practice? – Bilateral ECT.
- Advantages of unilateral ECT? – Less complication and Less confusion.
- Do nurses provide which position during ECT electrodes are placed in unilateral ECT? – D-Elias position.
- Depression patients require a total ECT ?- of 6 – 8 times.
- ECT Consent should be collected by? – Patient.
- Position of a patient, during ECT therapy? – Supine Position.
- What is the important nursing action during ECT? – Observe the intensity of seizures.
- Control the intensity of seizures during ECT by the – Thiopentane sodium.
- The most common complication occurs after ECT therapy. – Retrograde amnesia.
- Most common fractures occur after the ECT therapy. – Mandible/jaw fracture.
- What is the complication of ECT attained by nurses according to priority? – Respiratory distress.