1 2 3 4 5 6 Automated External Defibrillation 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, EMTs, First Responders, Police Officers Airports, Department Stores, Aircraft Emergency Cardiac Care Chain of Survival Composed of 4 Links: 1. Early access 2. Early 3. Early defibrillation 4. Early advanced care Rationale for Early Defibrillation The most frequent initial cardiac rhythm in cardiac arrest is ventricular fibrillation (v-fib) The most effective treatment for v-fib is electrical defibrillation (d-fib) The probability of successful defibrillation diminishes rapidly over time V-fib tends to convert to within a few minutes More on Early Defibrillation Many adults in v-fib can survive if defibrillation is performed as late as minutes after the arrest (with CPR) The speed in which defibrillation is delivered is a major determining factor of the success of the resuscitation attempt By 4 to 8 minutes after the arrest, 50% of patients are still in V-fib Best chance is if d-fib is performed after minutes of pulselessness 1. Automated External Defibrillators (AED) Requires the operator to attach the only Automatically analyzes and shocks if needed Can be as the machine performs the 1
Automatically analyzes and shocks if needed Can be as the machine performs the shocks 7 8 9 10 11 2. Semi-automated External Defibrillators (SAED) Requires operator to initiate rhythm analysis Requires operator to the shock button if shock is advised Considered safest because it never enters the advisory or shock mode unless activated by the operator 3. Manual defibrillators Every function is controlled Requires extensive training Requires interpretation of rhythm In the Pre-hospital setting, normally only used by Automated Analysis of Cardiac Rhythms AEDs have been extensively tested in laboratories and in field studies Accuracy of the AEDs have been very Most errors have been determined to be errors Advantages of AEDs Limited amount of training required requires no training of EKG interpretation easier to learn than CPR Allows for remote, defibrillation Some models are very inexpensive Disadvantages to AEDs All motion must be Cost of units and supplies 2
12 13 14 15 All motion must be Cost of units and supplies Requires continuing, ongoing training Requires maintenance and periodic checks and tests Use of SAEDs SAEDs should only be applied to patients who are unconscious, not breathing, and pulseless Operational Steps 1. Turn on the r 2. Attach the device 3. Initiate analysis of the rhythm 4. Deliver the shock, if indicated One team member begins BLS 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, immediately apply and use the SAED Place SAED in a location where it is easily viewed and reached. Use the voice recorder if so equipped Place pads on patient remove clothing chest should be and dry excessive hair should be shaved white (-) lead over sternal border red (+) lead on lower-left ribs over the apex CPR and transport must be stopped prior to analyzing Rescuer must announce prior to shocking patient Rescuer must visually check to make sure everyone is clear from patient Most SAEDs have visual and audio prompts If SAED states No Shock Advised, continue and request ALS backup 3
16 17 18 19 If SAED states No Shock Advised, continue and request ALS backup One shock is given followed by immediate CPR for 2 minutes. Shock is for adults using monophasic defibrillators or biphasic equivalent. Do not 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 2 minutes of CPR Pediatric Defibrillation Use of an AED is recommended for all patients in cardiac arrest one year of age and older Use Pediatric D-fib pads if available If not, use adult pads placed in the anterior/posterior positions on small children Use pediatric settings if available If pediatric settings are not available, use the adult settings Normal Sinus Rhythm Course Ventricular Fibrillation 20 Fine Ventricular Fibrillation 21 Ventricular Tachycardia 4
22 Asystole 23 24 25 Transport Considerations Keep AED attached. Check pulse frequently. Transport: When patient regains After delivering 2-3 single shocks with 2 minutes of CPR in between After receiving 2-3 consecutive no shock advised messages Stop ambulance to use an AED. Coordination with ACLS Backup ACLS personnel (Paramedic) is in charge ACLS personnel should allow EMT to finish sequence before taking over SAED should be removed unless it is equipped with a manual override Key Points Some AEDs are set to shock times per cycle, newer ones are set to shock 1 time per cycle Follow the verbal instructions of the AED make sure everyone is cleared before shocking 5