Automated External Defibrillation

1. Automated External Defibrillation

2. Principle of Early Defibrillation • States that all BLS personnel be trained, equipped and allowed to operate a _______________________ if they are expected to respond to persons in cardiac arrest • Firefighters, _______________________ , First Responders, Police Officers • Airports, Department Stores, _______________________

3. Emergency Cardiac Care “Chain of Survival” Composed of 4 Links: 1. Early _______________________ 2. Early _______________________ 3. Early _______________________ 4. Early _______________________ care

4. Rationale for Early Defibrillation • The most frequent initial cardiac rhythm in sudden cardiac arrest is ventricular _______________________ (v-fib) • The most effective treatment for v-fib is electrical _______________________ (d-fib) • The probability of successful defibrillation diminishes rapidly over time • V-fib tends to convert to _______________________ within a few minutes

5. More on Early Defibrillation • Many adults in v-fib can survive if defibrillation is performed as late as 6-10 minutes after the _______________________ (with CPR) • The speed in which defibrillation is delivered is a major determining factor of the _______________________ of the resuscitation attempt • By 4 to 8 minutes after the arrest, _____________% of patients are still in V-fib • Best chance is if d-fib is performed after ___________ minutes of pulselessness

6. Types of Defibrillators 1. _______________________ External Defibrillators (AED) • requires the operator to attach the pads only • automatically analyzes and _______________________ if needed • Can be dangerous as the machine performs the shocks

7. Types of Defibrillators 2. Semi-automated External Defibrillators (SAED) • Requires operator to initiate rhythm _______________________ • Requires operator to push the _______________________ button if shock is advised • Considered _______________________ because it never enters the advisory or shock mode unless activated by the operator

8. Types of Defibrillators 3. _______________________ defibrillators • Every function is manually controlled • Requires extensive _______________________ • Requires interpretation of _______________________ • In the Pre-hospital setting, normally only used by _______________________

9. Automated Analysis of Cardiac Rhythms • AEDs have been extensively tested in laboratories and in field studies • _______________________ of the AEDs have been very high • Most errors have been determined to be _______________________ errors

10. Advantages of AEDs • Limited amount of _______________________ required • requires no training of EKG interpretation • easier to learn than _______________________ • Allows for remote, “hands free” defibrillation • Some models are very _______________________

11. Disadvantages to AEDs • All _______________________ must be stopped • Cost of units and supplies • Requires continuing, _______________________ training • Requires maintenance and periodic checks and tests

12. Use of SAEDs • SAEDs should only be applied to patients who are unconscious, not breathing, and _______________________ Operational Steps 1. Turn on the _______________________ 2. _______________________ the device 3. Initiate _______________________ of the rhythm 4. Deliver the _______________________ , if indicated

13. Standard Operational Procedures • One team member begins _______________________ • If unknown how long the patient has been down, perform ___________ minutes of CPR prior to applying SAED • If collapse is witnessed or adequate CPR has been performed, _______________________ apply and use the SAED • Place SAED in a _______________________ where it is easily viewed and reached. • Use the voice recorder if so equipped

14. Standard Operational Procedures • Place pads on patient • remove _______________________ • chest should be clean and _______________________ • excessive hair should be _______________________ • white (-) lead over upper-right sternal border • red (+) lead on lower-left ribs over the apex • CPR and _______________________ must be stopped prior to analyzing

15. Standard Operational Procedures • Rescuer must announce “_______________________ ” prior to shocking patient • Rescuer must _______________________ check to make sure everyone is clear from patient • Most SAEDs have visual and _______________________ prompts • If SAED states “No Shock Advised”, continue CPR and request ALS backup

16. Standard Operational Procedures • One shock is given followed by immediate CPR for 2 minutes. • Shock is ___________J for adults using monophasic defibrillators or biphasic equivalent. • Do _______________________ check pulse, begin immediate CPR for 2 minutes unless patient regains consciousness • Use of ____________ shocks is acceptable until AED is replaced or updated • Re-analyze after ___________ minutes of CPR

17. Pediatric Defibrillation • Use of an AED is recommended for all patients in cardiac arrest _______________________ year of age and older • Use Pediatric D-fib _______________________ if available • If not, use adult pads placed in the anterior/posterior positions on small children • Use _______________________ settings if available • If pediatric settings are not available, use the adult settings

18. EKG Rhythms Normal Sinus Rhythm

19. EKG Rhythms Course Ventricular Fibrillation

20. EKG Rhythms Fine Ventricular Fibrillation

21. EKG Rhythms Ventricular Tachycardia

22. EKG Rhythms Asystole

23. Transport Considerations • Keep AED _______________________ . • Check _______________________ frequently. • Transport: • When patient regains pulse • After delivering ________________ single shocks with 2 minutes of CPR in between • After receiving 2-3 consecutive “no shock advised” messages • Stop _______________________ to use an AED.

24. Coordination with ACLS Backup • ACLS personnel (_______________________ ) is in charge • ACLS personnel should allow EMT to finish CPR sequence before taking over • SAED should be _______________________ unless it is equipped with a manual override

25. Key Points • Some AEDs are set to shock __________ times per cycle, newer ones are set to shock __________ time per cycle • Follow the _______________________ instructions of the AED • ALWAYS make sure everyone is cleared before shocking