COALINGA STATE HOSPITAL. NURSING POLICY AND PROCEDURE MANUAL SECTION Emergency Procedures POLICY NUMBER: 716. Effective Date: March 3, 2007

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1 COALINGA STATE HOSPITAL NURSING POLICY AND PROCEDURE MANUAL SECTION Emergency Procedures POLICY NUMBER: 716 Effective Date: March 3, 2007 SUBJECT: MONITOR/DEFIBRILLATOR 1. PURPOSE: This policy and procedure will provide staff with guidelines for the appropriate care and use of the AED 2. POLICY: All available nursing staff (RN, LVN, PT) shall respond immediately to any medical emergency and be prepared to cooperate in utilizing the equipment and medical skills necessary to provide immediate and appropriate nursing interventions. 2. An AED shall be brought to the scene of all medical emergencies. AEDs are currently available on all floors between housing units. The AED s in the administration building are in the front hall and back hall by the training department and up stairs outside the executive suite. 3. The AED shall be utilized in the following methods: 4. In a medical emergency, (e.g. code blue), all BLS certified staff may use the AED appropriately as per the American Heart Association. 3. GENERAL INFORMATION/DEFINITIONS: The emergency cardiac care systems concept identifies early access to the EMS system, early CPR, early defibrillation, and early advanced cardiac care as the best approach to treatment of persons in cardiac arrest. The major determinant in successful resuscitation is time. The earlier defibrillation occurs, the better the prognosis. Emergency medical responders have only a few minutes after the collapse of a victim to reestablish a sustained perfusing rhythm. CPR can sustain an individual for a short period but cannot directly restore an organized rhythm. Restoration of an adequate perfusing rhythm requires defibrillation and advanced cardiac care, which must be administered within a few minutes of the initial arrest. Defibrillation is the therapeutic use of electric current delivered in large amounts over very brief periods of time. The defibrillation shock temporarily depolarizes (producing asystole on the monitor) an irregularly beating heart (e.g. ventricular fibrillation or -1- N.P.P No. 716

2 pulseless ventricular tachycardia) and thus allows more coordinated contractile activity to resume. A defibrillator is an instrument that delivers an electrical shock to the heart. The AED incorporates a rhythm analysis system and require operator interventions including turning AED on to initiate rhythm analysis and pressing shock button to deliver the defibrillation. The AED recognizes ventricular fibrillation and ventricular tachycardia with a rate higher than 180 bpm as shockable rhythms. Ventricular fibrillation is a rhythm in which multiple areas of the ventricles display marked variation in depolarization and repolarization. The ventricles do not contract as a unit and there is no cardiac output. Ventricular fibrillation is the most frequent initial rhythm in sudden cardiac arrest. Only defibrillation provides definitive therapy. The chance of successful defibrillation diminishes rapidly over time (minutes). Pulseless ventricular tachycardia should be treated the same as ventricular fibrillation. 4. GENERAL INFORMATION FOR THE SEMI-AUTOMATIC ZOLL 1600 MONITOR/DEFIBRILLATORS: 1. The AED is employed by BLS certified trained personnel to revive victims of ventricular fibrillation, and pulseless ventricular tachycardia. 2. The Fire Department staff will validate and document monthly the operational status, and contents of supplies such as electrode pads, face masks, razor and gloves. This will include battery life, and any expiration dates on any of the equipment). 3. Training on the use of the AED will be done in New Employee Orientation and every two years after by the training department and affiliates. 4. Training on use of the AED will be offered to all staff through the training department. 5. All staff are responsible for notifying Fire Services immediately if a red X is noted in the bottom left corner indicating a LOW BATTERY: Battery should be removed and replaced with charged battery. 6. Practice may be done on units, using the simulator in the case of the AED. The NOD/RN may be contacted for mock codes 7. After any use of the AED, NOD/HSS must be informed. Battery and all used supplies must be replaced. 5. ASSESSMENT: 1. SUBJECTIVE: There may be history of coronary artery disease, cardiac dysrhythmia, drug overdose, or drug toxicity. 2. OBJECTIVE: A+B+C = Full Cardiac Arrest A. Unresponsiveness and B. Breathlessness and C. Pulselessness, D. Shock may be advised by the AED. 3. ASSESSMENT/DIAGNOSIS: Cardiac arrest with shockable rhythms (ventricular fibrillation and ventricular tachycardia with a rate over 180bpm). -2- N.P.P No. 716

3 4. PLAN: All staff BLS certified and trained in the use of the AED will defibrillate shockable rhythms as indicated by the AED. 6. TREATMENT: A. Verify full cardiac arrests. B. CPR until AED is attached. C. Make sure all movement affecting the individual has ceased during analization and no one is touching the individual I m clear, you re clear, all clear before pushing the treatment button. D. Follow the American Heart Association Automated External Defibrillation (AED) treatment plan. 7. PHYSICIAN INTERVENTION: Turn over the resuscitation responsibility to full ACLS personnel directed by a physician/outside qualified rescuer or team after they have arrived and assessed the individual. 8. FOLLOW-UP: Continue to participate in the resuscitation efforts as directed by the team leader. Prepare to transfer the individual if so ordered. 9. EXPECTED OUTCOMES: The individual s chance of survival and pre-arrest functioning will be optimized. 10. PRECAUTIONS: 1. Never use in the presence of flammable agents. 2. Do not unnecessarily touch or move the individual when the defibrillator is attached and operating. Contact with the victim during analyzing may delay shock delivery. 3. STAY CLEAR OF VICTIM! Any contact with the victim during shock delivery may expose the operator to an electrical shock. Any contact with victim during analyze mode may result in inaccurate analysis. 4. Turn the device off to disarm and dump unwanted charge. 5. Remove any medication patches and residue prior to applying electrodes. Defibrillation through medication patches on the individual s skin may cause current to be redirected, burning the individual. -3- N.P.P No. 716

4 6. Nitroglycerin paste or wet conditions can cause poor pad contact or electrical arcing between pads. Quickly wipe or dry skin before applying pads. 7. Avoid placing pads directly over implanted pacemakers or internal defibrillators. Safety and delivery of external defibrillation will not be affected but the implanted device will probably be permanently disabled. 11. COMPETENCY/TRAINING: All staff in the training departments category one and two and those required in category three will receive AED training as part of their new employee orientation and every two years thereafter. (Category one includes lic. staff and all staff in direct contact with the individuals served at CSH, Category two includes staff in CPS, radiology, work crew supervisors, ACNS, PD, PA and NC s, Category three receiving such training are the custodians supervising work crews. 12. EQUIPMENT: AED Emergency Drug Box (x 2) Emergency Response Vehicle 13. PROCEDURE FOR AED: NURSING ACTION KEY POINTS 1. Set AED near the individual 1. Does not require an order to use the AED 2. Turn on the defibrillator 3. Remove clothing from the individual s chest. Wipe chest dry if it is damp. 4. Open AED pads and place on chest as diagramed. No contact with patient during analysis 2. Follow verbal cues 3. Respect individual s privacy. 4. Ensure pads stick firmly and evenly to the skin of the chest. If needed there is a razor provided to shave hair from chest. The pads are adjustable to accommodate different size individuals. 5. If a shockable rhythm is detected, a 5. If this occurs, verify individual s -4- N.P.P No. 716

5 voice will say PRESS Treatment button Ensure all assisting personal are standing clear of patient before pushing the treatment button Position and that everyone is clear of the patient before pressing the button 6. Resume CPR upon prompts 6. To ensure adequate O2 and compressions. 14. DOCUMENTATION: A. Enter ID notes. B. Document in or give input for the Medical Emergency Flow Sheet (CSH #7107) and Medical Emergency/Code Blue Survey Questionnaire (CSH #109), Post- Emergency Critique and Ideas questionnaire. These should be given to the NOD for delivery to the Chair of the Emergency Care Committee for review. 15. CROSS - REFERENCES: ADMINISTRATIVE DIRECTIVES: A.D Medical Emergencies NURSING POLICY & PROCEDURES: NP&P Manual Section (Emergency Procedures) -5- N.P.P No. 716