EMT Defibrillation A LWTC/NSCC presentation. Objectives Understand cardiac arrest physiology and...

EMT DefibrillationEMT Defibrillation

A LWTC/NSCC presentation

ObjectivesObjectives

Understand cardiac arrest physiology and impact CPR/AED has on patient outcomes

Demonstrate knowledge and understanding of AED use in role as the EMT/Defib Tech in cardiac arrest

Some StatisticsSome Statistics

Seattle-King County EMS agencies responded to 1035 cardiac arrest patients in 2007

302 (29%) of these patients initially presented in VF/VT

Survival rate (post VF arrest) for Seattle-King County is 45%

GoalsGoals

Quality CPR is to be performed and interrupted for a minimal amount of time

VF/VT to be shocked as soon as defibrillator is available

Overall patient care and safety are never to be neglected

Your Goal…Your Goal…

Basic Cardiac Basic Cardiac PhysiologyPhysiology

Normal Cardiac ConductionNormal Cardiac Conduction

Electrical pattern ECG tracing

Cardiac ArrestCardiac Arrest

Occulsion of the coronary artery leads to ischemia

Ischemia leads to infarct which causes interruption of normal cardiac conduction

Infarct = VF/VT

Shockable RhythmsShockable Rhythms

Ventricular Fibrillation Ventricular Tachycardia

Defib ProcedureDefib Procedure

EquipmentEquipment

AED is capable of analyzing shockable rhythms

Delivers biphasic shock (120-200 joules)

Can be used for pediatric pts (< 8) with adult/pediatric pads

Defibrillation BasicsDefibrillation Basics

Shockable rhythm is defined as VF or unconscious/pulseless VT.

CPR must be performed with minimal interruptions except in cases of airway management (aspiration of emesis)

Defibrillation BasicsDefibrillation Basics

Before the AED can be turned on the patient must be:– Unconscious– Unresponsive– Apneic– Pulseless

Defib ProcedureDefib ProcedureCheck for consciousness/responsiveness.Access ABCs. If not breathing, open

airway & begin ventilations.Check pulse. If pulse not present, initiate

CPR.Turn on defibrillator, apply pads, begin

verbal report.Allow defibrillator to analyze (stop CPR)

Pad PlacementPad Placement

AED will analyze…AED will analyze…

…shockable rhythm of VF/pulseless VT and deliver command to deliver shock

OR

…non-shockable rhythm and deliver command to resume CPR

Shock Advised (VF or VT)Shock Advised (VF or VT)

Clear patient from head to toe (SAFETY!)Deliver single shockImmediately begin CPR and continue for 2

minutes.Do not delay CPR for pulse check or post-

shock rhythm analysis.

Shock Advised (VF or VT)Shock Advised (VF or VT)

After 2 minutes of CPR, analyze rhythm (stop CPR)

No pulse check requiredIf shock is indicated, clear patient, and

deliver 2nd shock.Continue uninterrupted CPR for 2 minutes

Shock Advised (VF or VT)Shock Advised (VF or VT)

After 2 minutes of CPR, analyze rhythm (stop CPR)

No pulse check requiredIf shock is indicated, clear patient, and

deliver 3rd shock.Continue uninterrupted CPR for 2 minutes.

Shock Advised (VF or VT)Shock Advised (VF or VT)

After 2 minutes of CPR, analyze rhythm (stop CPR)

No pulse check requiredIf shock is indicated, clear patient, and

deliver shock.Continue uninterrupted CPR for 2 minutes.Continue process until Medic arrival

No Shock AdvisedNo Shock Advised

Immediately begin CPRContinue uninterrupted CPR for 2 minutesDo not delay CPR for pulse check

No Shock AdvisedNo Shock AdvisedAfter 2 minutes of CPR, analyze rhythm

(stop CPR)Do not check pulse before analyzing

rhythmIf No Shock is advised, check pulse.No pulse, continue uninterrupted CPR for 2

minutes

No Shock AdvisedNo Shock Advised

If pulse is present after pulse check, obtain patient’s blood pressure, check airway to ensure it is clear, and assess breathing for adequate breathing.

Assist ventilations if inadequate.If blood pressure < 60 mmHg systolic,

perform uninterrupted CPR for 2 minutes

No Shock AdvisedNo Shock AdvisedAfter 2 minutes of CPR, analyze patient

(stop CPR)Do not check pulse before analyzing rhythmIf No Shock advised, check pulse.If no pulse, continue uninterrupted CPR for

2 minutesAfter 3rd No Shock, continue CPR without

analyzing patient

SafetySafety

SafetySafety

Defib tech is in charge at ALL times!You are responsible for the overall

quality of airway management, CPR, and safe, effective defibrillation

Be sure to clear patient from head-to-toe prior to delivering shock

Special CircumstancesSpecial Circumstances

Pediatric patients (< 1 year old)Trauma patientsHypothermia

Questions?Questions?