Aed Guide Revision Feb 14 2012 Draft

7/23/2019 Aed Guide Revision Feb 14 2012 Draft

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DEFIBRILLATION AND THEAUTOMATIC EXTERNAL DEFIBRILLATOR

A GUIDE

Defibrillation and the AED, A guide Revised February 2012 Page 1 of 22


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Original document complied by Pat Standen, Grampians Trauma, Emergency & Critical Care

Coordinator

ACKNOWLEDGEMENTS

Sue Garner, Clinical Educator, Intensive Care/Coronary Care Unit, Ballarat Health Services,Amber van Dreven, Clinical Educator, Emergency Department, Ballarat Health Services andGeoff McCurdy, Director of Pharmacy, Ballarat Health Services for reviewing the original

document and providing their expert advice.

Thank you to Wendy Porteous, Clinical Educator Emergency Department, Ballarat HealthServices for reviewing and revising this version 2012

Ballarat Health Services andAmbulance Victoria for so generously allowing their clinicalpractice guidelines to be used as a guide.

For information regarding this Guide contact:Pat StandenDepartment of HealthPO Box 712

Ballarat 3353Email: [email protected]: 03 5333 6026

Version Date Major Changes Page No1.0 September 2005

1.1 January 2008 Basic Life Support Flowchart

AED FlowchartCompetency Assessment formBasic Life Support Table

16

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2.0 February 2012 Section 3Basic life support flowchart

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DISCLAIMER:

Care has been taken to confirm the accuracy of the information presented in this guide, however, the authors, editors

and publisher are not responsible for errors or omissions or for any consequences from application of the information

in the guide and make no warranty, express or implied, with respect to the contents of the publication.

Every effort has been made to ensure the clinical information provided is in accordance with current

recommendations and practice. However, in view of ongoing research, changes in government regulations and theflow of other information, the information is provided on the basis that all persons undertake responsibility for

assessing the relevance and accuracy of its content.



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TABLE OF CONTENTS

Page

INTRODUCTION 4

SECTION 1

BRIEF REVIEW OF THE HEART 5

1.1 Anatomy 5

1.2 Coronary Arteries 6

1.3 The Conduction System 8

SECTION 2

THE ELECTROCARDIAGRAM 9

2.1 ECG Complex 9

2.2 ECG Grid Paper 10

SECTION 3

CARDIAC RHYTHMS AND DEFIBRILLATION 11

3.1 What is Defibrillation 11

3.2 Types of AEDs 11

3.3 Sequence of actions when using the AED 12

3.4 Position of Pads 12

3.5 Pads 153.6 Rhythms:

Ventricular Tachycardia 16

Ventricular Fibrillation 17

3.7 Defibrillation Safety 18

3.8 Procedure 18

Basic Life Support Flowchart 20

REFERENCES 21

SUGGESTED FURTHER READING 21



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INTRODUCTION

The purpose of this guide is to assist educators in the Grampians Region to design their ownHealth Service specific package for Registered Nurses Division 1, and others, required to usean Automatic External Defibrillator (AED). There are a number of these devices available forpurchase; the aim of this guide is to provide generic information based on principles of care.

It is the responsibility of each individual practitioner and Health Service to ensure appropriateeducation for all equipment and that competency in the use of the equipment is maintained.

The use and education around the AED should be undertaken in conjunction with Basic LifeSupport (BLS) and Laryngeal Mask Airway (LMA) management.

Please note:

Any person wishing to use this material must review the materials prior to use and ensurethey are suitable for the purpose, including the needs of educators and intended trainingrecipients. Some aspects of the materials may not be relevant.

The accuracy and appropriateness of the materials may not suit all circumstances, and thematerials may not include all the information required.

Any person using the materials does so at their own risk and shall accept responsibility forany actions arising from their use. No responsibility is taken for failure to update the materialsand it is the responsibility of the person to ensure that the information contained in thematerials is up to date and reflects current practice, law and guidelines.



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SECTION 1

1.0 A BRIEF REVIEW OF THE HEART

1.1 Anatomy

Approximately the size of a persons fist, the heart weighs between 250 and 300grams. It sitswithin the mediastinum and extends from the second rib to the fifth intercostal space. Itassumes an oblique position in the thorax; approximately two-thirds of its mass is left of the

midsternal line with the balance projecting right. The broad superior portion is approximately9cms wide and is directed towards the right shoulder. The pointed apex is directed towardsthe left hip and rests on the diaphragm.

The heart consists of four chambers, two atria and two ventricles. There is a valve throughwhich blood passes before leaving each chamber of the heart. The valves prevent thebackward flow of blood. These valves are actual flaps that are located on each end of the twoventricles. They act as one-way inlets of blood on one side of a ventricle and one-way outletsof blood on the other side of a ventricle. Each valve actually has three flaps, except the mitralvalve, which has two flaps. The four heart valves include the following:

Tricuspid valve: located between the right atrium and the right ventricle

Pulmonary valve: located between the right ventricle and the pulmonary artery

Mitral valve: located between the left atrium and the left ventricle

Aortic valve: located between the left ventricle and the aorta

http://housemedicalcenter.com/wp-content/uploads/2011/05/interion-view-of-the-heart.gif



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1.2 Coronary Arteries

Coronary arteries supply blood to the heart muscle. Like all other tissues in the body, the

heart muscle needs oxygen-rich blood to function. The coronary arteries consist of two mainarteries: the right and left coronary arteries, and their two branches, the circumflex arteryand the left anterior descending artery.

http://www.cumc.columbia.edu/dept/rehab/images/Pages%20from%20cardiac-4_img_0.jpg

The left coronary artery (LCA), divides into the left anterior descending artery and thecircumflex branch, and supplies blood to the ventricles and left atrium.

The right coronary artery (RCA), divides into the right posterior descending artery anda large marginal branch, supplies the ventricles, right atrium, and sinoatrial node.

The circumflex artery (Cx) branches off the left coronary artery and encircles the heartmuscle. This artery supplies blood to the back of the heart.

The left anterior descending artery (LAD) branches off the left coronary artery andsupplies blood to the front of the heart



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CoronaryArtery:

Area and Structures Supplied: Complications resulting fromocclusion:

RightInferior wall of left ventricle

Sinus node (55% of individuals)AV node (90% of individuals)Bundle of His (90% of individuals)Posterior inferior division of left bundle(a portion)Vagus nerve fibresRight bundle branch (superior one-third)

Inferior STEMI, Posterior STEMI

and/or Right Ventricular STEMIConduction blocks -

First degree heart block

Second degree Type I andType II heart block

Third degree heart blockBradyarrhythmiasHypotension

LeftAnterior wall of left ventricle (LAD)

Posterior wall of left ventricle (LCX)Sinus node (45% of patients) (LCX)

AV node (10% of patients) (LCX)Right bundle branch (inferior two-thirds)Anterior superior division of leftbundle branchPosterior inferior division of left bundlebranch (a portion)

LAD: Left anterior descending arteryLCX: Left circumflex artery

Anterior STEMI

Heart failureTachyarrhythmias associated with

heart failureConduction blocks -

Right bundle branch block

Left anterior hemiblock

Left posterior hemiblock

First degree heart block

Second degree Type II

Third degree heart block

Potential aneurysm formationVT/VF



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1.3 The Conduction system:

http://4.bp.blogspot.com/_zb7BqrrxGWI/Swf5PAAep6I/AAAAAAAAAIs/tT_Va89y4io/s1600/Cardiac+conduction.gif

The ability of the heart muscle to depolarise is intrinsic. About 1% of the cardiac muscle fibresbecome auto-rhythmic: they repeatedly and rhythmically generate action potentials. Theseauto-rhythmic fibres serve two functions; the pacemaker, setting the rhythm for the entireheart and the conduction system, the route for depolarisation to occur.

Sinoatrial (SA) node located in the right atrial wall inferior to the opening of the

inferior vena cava the normal pacemaker of the heart rate approx 70 80 per minute(sinus rhythm). The wave of depolarisation spreads through the two atria and ends up

at the AV node.

Atrioventricular (AV) node located in the septum between the two atria. The impulsefrom the SA node is delayed for about 0.1 sec at the AV node to allow the atria tocomplete their contraction. The impulse then travels rapidly through the AV bundle

(Bundle of His) and enters both the right and left bundle branches. The pacemaker rateof the AV node is 40 50.

Bundle branches right and left, course through the interventricular septum towards

the apex of the heart.

Purkinje fibres because the left ventricle is larger than the right the Purkinje networkis greater on the left. Conduction occurs at the apex of the ventricular myocardium firstthen travels upward. Approx O.20 secs after the atria contract the ventricles contract.The pacemaker rate is approx 20 40.



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SECTION 2

2.0 THE ELECTROCARDIOGRAPH

2.1 E.C.G. Complex

P WAVE -The first wave represents depolarisation of the atria. The impulse usually comes from the SAnode, which is the chief pacemaker of the heart and is situated in the right atrium. The

general wave of depolarisation is downwards and towards the left hand side of the body.The P wave is generally not higher (amplitude) than 2-3mm and no longer than 0.10 0.11of a second in duration. It is normally upright in Lead I, Lead II, aVF, V3 V6. It may beinverted in aVR, may be biphasic in V1 and V2, and may be occasionally inverted in Leads Iand II and aVL.

PR INTERVAL This interval represents the time taken for the impulse to go through the atria, across the AVnode and junction and down the Bundle of His. It is measured from the beginning of the Pwave to the beginning of the QRS. Normal duration 0.12 0.20 seconds.

QRS

This complex follows the P wave, PR interval and represents the depolarisation of theventricles. Depolarisation comes through the AV node, then goes through the septum andthen through the left and right ventricles. The general wave is downwards and to the left ofthe body.The QRS is usually 0.04 0.10 of a second in duration and between 5mm and 125mm inamplitude, depending on the lead.

The Q wave is the first downward deflection preceding the R or S wave. If there isno R wave it is termed a QS wave. The Q wave is normally less than 0.04 seconds in

duration, and less than a of the R wave. Q waves in Lead III and aVF may varywith inspiration. The R wave first upward deflection of the QRS complex usually less than 0.01

second in duration. The R wave in V6 represents left ventricle activity. The R wave inV1 represents right ventricle activity. The S wave first downward deflection following R wave is rarely deeper than6mm and may be absent. An S wave in V1 represents left ventricle activity. An Swave in V6 represents right ventricle activity.

ST SEGMENT This segment represents the refractory period of the ventricles. The point where the QRS

joins the ST segment is called the J point.

The ST segment duration varies with the cardiac rate and ranges from zero to 0.15 seconds.It is normally iso-electric (on the baseline) because positive and negative forces are equal

during this period.

T WAVE This usually starts at the iso-electric line and varies in shape. It represents rapidrepolarisation of the ventricles. Its amplitude is usually from 5mm 10mm. It can beupright in Lead I, Lead II, V3 to V6 inverted in aVR and variable in other leads.Following the T wave a U wave of low voltage is sometimes seen, it may represent the slowrepolarisation of the ventricles. It is usually difficult to see.



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QT INTERVAL This interval measures the total time taken for depolarisation and repolarisation of theventricle. It is measured from start of the QRS to end of the T wave. Its duration varies with

age, sex and cardiac rate, but usually is about 0.35 0.42 seconds. As a general rule QTshould be less then of the R R interval.

2.2 ECG Grid Paper

https://reader009.{domain}/reader009/html5/0319/5aaed31d8828d/5aaed3225f553.jpg

Measurements of paper and the complex: P wave 0.20 sec

PR interval 0.12 0.20 sec

QRS interval 0.07 0.10 sec

ST segment measurement not significant, elevation or depression is moreimportant

QT segment measurement depending on heart rate

Calculation of Heart RatePaper speed: 25mm/sec therefore 5 large boxes = 25mm or 1 sec therefore 300boxes = 1

minute

If heart rate regular:Measure the interval between the complexes (R R interval) and divide into 300For example: 1 complex every large box = Rate 300bpm

1 complex every 2 large boxes = rate 150bpm1 complex every 3 large boxes = rate 100bpm1 complex every 4 large boxes = rate 75bpm1 complex every 5 large boxes = rate 60bpm

OR

If the heart rate irregular:15 large boxes = 3 secs therefore 30 large boxes = 6 secsCount the complexes in a 6 second interval and multiply by 10 to get the rate per minute.



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SECTION 3

3.0 CARDIAC RHYTHMS & DEFIBRILLATION

3.1 What Is Defibrillation?

The passage of an electrical current across the myocardium of sufficient magnitude todepolarise a critical mass of myocardium, and enable restoration of coordinated electricalactivitySource: Deakin et al (2010)

Mechanism of defibrillationIt is thought that successful defibrillation occurs when a critical mass of myocardiumis depolarised by the passage of an electric current (RCUK, 2011). This will then hopefullyenable the sinoatrial node (the hearts normal pacemaker) or another intrinsic pacemaker toregain control of the heartbeat (Jevon, 2009).

REMEMBER : EARLY DEFI BR I L LAT I ON PROV I DES THE BEST CHAN CE OF SURV I VAL I N

VF OR PU LSELESS VT

Defibrillation refers to the current of electricity passing through the heart and it occurs at a

random point in the cardiac cycle (unsynchronised). Defibrillation produces simultaneousdepolarisation of the mass of myocardial cells and enables the resumption of organisedelectrical activity.

3.2 Types of automated external defibrillator

AEDs are sophisticated, reliable, safe, computerised devices that deliver electric shocksto victims of cardiac arrest when the ECG rhythm is one that is likely to respond to ashock. Simplicity of operation is a key feature: controls are kept to a minimum, voiceand visual prompts guide rescuers. Modern AEDs are suitable for use by both lay

rescuers and healthcare professionals.All AEDs analyse the victims ECG rhythm and determine the need for a shock. Thesemi-automatic AED indicates the need for a shock, which is delivered by the operator,

while the fully automatic AED administers the shock without the need for intervention bythe operator. Some semi-automatic AEDs have the facility to enable the operator(normally a healthcare professional) to override the device and deliver a shockmanually, independently of prompts.

Examples of some of the automatic external defibrillators available:

Welch Allyn AED 10 Powerheart AED G3http://www.welchallyn.com/products/en-us/x-11-ac-100-0000000001041.htm http://www.powerheart.com/products/phaed_g3auto.htm

http://www.welchallyn.com/products/en-us/x-11-ac-100-0000000001041.htmhttp://www.powerheart.com/products/phaed_g3auto.htmhttp://www.powerheart.com/products/phaed_g3auto.htmhttp://www.welchallyn.com/products/en-us/x-11-ac-100-0000000001041.htm


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Phillips HeartStart FR2 Zoll AED

http://www.medical.philips.com/main/products/resuscitation/index2.html http://www.zoll.com.au/products/aed_plus/literature/AED_Plus_Brochure.pdf

3.3 Sequence of actions when using an automated external defibrillator

The following sequence applies to the use of both semi-automatic and automatic AEDsin a victim who is found to be unconscious and not breathing normally.

1. Follow the adult BLS sequence. Do not delay starting CPR unless the AED isavailable immediately.2. As soon as the AED arrives:

If more than one rescuer is present, continue CPR while the AED is switched on. Ifyou are alone, stop CPR and switch on the AED.

Follow the voice / visual prompts.

Attach the electrode pads to the patients bare chest.

Ensure that nobody touches the victim while the AED is analysing the rhythm.3A. If a shock is indicated:

Ensure that nobody touches the victim. Push the shock button as directed (fully-automatic AEDs will deliver the

shock automatically).

Continue as directed by the voice / visual prompts.

Minimise, as far as possible, interruptions in chest compression.

3B. If no shock is indicated:

Resume CPR immediately using a ratio of 30 compressions to 2 rescuebreaths.

Continue as directed by the voice / visual prompts.4. Continue to follow the AED prompts until:

qualified help arrives and takes over OR

the victim starts to show signs of regaining consciousness, such as

coughing, opening his eyes, speaking, or moving purposefully AND starts tobreathe normally OR

you become exhausted.

3.4 Position of Pads

The electrode positions are generally standard (you can refer to the instructions on yourAED). The apex pad is placed over the 6 thintercostal space, anterior chest wall, mid axillaryline. The sternal pad is placed with its top in the 2 nd intercostal space, just right of thesternum.

http://www.zoll.com.au/products/aed_plus/literature/AED_Plus_Brochure.pdfhttp://www.zoll.com.au/products/aed_plus/literature/AED_Plus_Brochure.pdf


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http://www.lbfdtraining.com/Pages/emt/sectione/aed_files/image038.jpg

Female Electrode Pads Zoll One-Piece Pads

Female Electrode Pads Two Piece Pads Position

http://www.lbfdtraining.com/Pages/emt/sectione/aed_files/image038.jpghttp://www.lbfdtraining.com/Pages/emt/sectione/aed_files/image038.jpg


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Male Electrode Pads Zoll One-Piece Pads

Male Electrode Pads Two Piece Pads Positionhttp://www.australiandefibrillators.com.au/use-an-aed.html

3.5 The Pads

The standard defibrillation pads for AEDs are about the size of your hand and are made of softthin foam coated on one side with a gel. The gel side is covered with a peel off backing whichis removed prior to placement on the chest. The backing is removed from one pad at a timeand the gel side firmly placed onto the patients bare chest (ensure moisture is wiped away

and the entire pad smoothed on firmly). Good pad contact will reduce the risk of skin burnsand reduce resistance to the current.

http://www.australiandefibrillators.com.au/use-an-aed.htmlhttp://www.australiandefibrillators.com.au/use-an-aed.html


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http://images-mediawiki-sites.thefullwiki.org/03/2/5/3/92649233828269596.jpg

Defibrillation if the victim is wet

As long as there is no direct contact between the user and the victim when the shock isdelivered, there is no direct pathway that the electricity can take that would cause theuser to experience a shock. Dry the victims chest so that the adhesive AED pads willstick and take particular care to ensure that no one is touching the victim when a shockis delivered.

Defibrillation in the presence of supplemental oxygenThere are no reports of fires caused by sparking where defibrillation was delivered usingadhesive pads. If supplemental oxygen is being delivered by a face mask, remove theface mask and place it at least one metre away before delivering a shock. Do not allow

this to delay shock delivery.

Minimise interruptions in CPRThe importance of early, uninterrupted chest compressions is emphasised throughoutthese guidelines. Interrupt CPR only when it is necessary to analyse the rhythm anddeliver a shock. When two rescuers are present, the rescuer operating the AED appliesthe electrodes while the other continues CPR. The AED operator delivers a shock assoon as the shock is advised, ensuring that no one is in contact with the victim.

CPR before defibrillationProvide good quality CPR while the AED is brought to the scene. Continue CPR whilstthe AED is turned on, then follow the voice and visual prompts. Giving a specifiedperiod of CPR, as a routine before rhythm analysis and shock delivery, is not

recommended.

3.6 Rhythms

There are four lethal rhythms Ventricular Tachycardia (VT) Ventricular Fibrillation (VF) Pulseless Electrical Activity Asystole

The two shockable rhythms, which the AED will recognise, are VT and VF. The AED reads the

ECG from the pads applied to the chest. Some AEDs have screens that show the rhythms,some do not. The AED identifies the heart rhythms. The operator does not need to be able toidentify the rhythm or decide if there is a need for defibrillation. It is however useful to have a

basic knowledge of heart rhythms.



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Ventricular TachycardiaRate variable from 140 to 250 beats per minuteP wave absent or obscured by the QRSVentricular rhythm usually regular but can be slightly irregular.

QRS complex wide and bizarre >0.12 seconds in duration.Significance The rapid rate of this arrhythmia reduces ventricular filling time. Cardiac

output may drop due to the dissociation of atrial and ventricular activity. Patient is at risk ofcardiovascular collapse.

I f p a t i e n t u n c o n s c i o u s , n o s i g n s o f l i f e

a t t a c h A ED a s s o o n a s p o s si b le a n d f o l l o w t h e p r o m p t s

Causes include

Hypoxia

Electrolyte disturbances

Myocardial infarction

R on T phenomenon

Coronary artery disease

Treatment Treat as soon as possible, this rhythm is usually a precursor to VF. Treatmentmay vary depending on whether there is a palpable pulse (often difficult to find) or patient isconscious or unconscious.

Amiodarone Potassium

Magnesium

T h i n k I s t h e r e a p u l s e? I s t h e p a t i e n t h a e m o d y n a m i ca l ly s t a b l e ?

Rhythm strip Ventricular Tachycardia

(Diagnosis should be made from the rhythm strip or the viewer on the AED. An ECG is not

required to diagnose unconscious/pulseless VT)

ECG Ventricular Tachycardia



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Ventricular FibrillationRate indeterminate

P wave not visibleVentricular rhythm chaotic irregular

QRS duration indiscernibleSignificance With VF the ventricles quiver rather than contract, they fail to pump bloodand cardiac output falls to zero.

Causes include

Myocardial infarction

Untreated VT

R on T phenomenon

Electrolyte imbalance

Acid base imbalance

Electric shock

Hypothermia

Treatment Early defibrillation provides the best chance of survival in patients with VF or

pulseless VT.

Rhythm Strip Ventricular Fibrillation

(Diagnosis should be made from the rhythm strip or the viewer on the AED. An ECG is not

required to diagnose VF)

ECG Ventricular Fibrillation



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3.7 Defibrillation Safety

Operators must be aware of the need for safety when using the AED.Considerations include:

Adult pads cannot be cut down to a smaller size

There should be no contact with patient (by anyone) during defibrillation

Check pad area for jewellery, ECG electrodes, pacemaker (if pacemakerpresent adjust pads) and medication patches

Think about conductive surfaces (water, fluids, metal)

Explosive environment (oxygen, gases, fumes)

Do not operate in an unstable environment which may prevent the AED fromperforming a valid assessment of the ECG signal (eg. rapidly moving vehicle)

Respond to all prompts within safety constraints.

Make sure all personnel are clear of the patient during analysis and prior toinitiating a shock.

Cellular phones, radios or other devices that emit electrical signals may interferewith the analysis of the AED and their use should be discouraged within 6 feet.

The use of AED in children (below 8yrs/40kgs) requires special pads. If the specialpads are not available, an unmodified adult AED may be used in children olderthan 1 year

3.8 Procedure

Collapsed patient

Remember chain of survival

1. Call for help.If you see someone collapse, immediately call for help and activate your emergencyprocedures. If there are other people around, choose someone specific and instruct them tocall for help and explain the situation. This decreases confusion about who should do whatand ensures that the call is being placed.2. Check the victim's breathing and airway.If someone has collapsed, you should immediately determine whether they are breathing. Ifthe victim is breathing, you know that they have a pulse. If the victim is not breathing, check

the airway is clear then begin CPR at 30 chest compressions at a depth of 4-5cm then 2breaths.3. Locate an AED.If there is an AED nearby, ask a bystander to take over CPR while you apply the AED chestelectrode pads to the victim. Uninterrupted CPR is an important factor in increasing therecovery rate of cardiac arrest patients. Always ensure that someone is providing CPR for thevictim unless the AED is actively analysing or shocking the victim.4. Turn on the AED.

Fo l lo w t h e v i s u a l & v o i c e p r o m p t s o f t h e A ED



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5. Attach the electrode pads to patients bare chest. (Expose the patients bare chest,male or female)First ensure that the adhesive AED pads are attached to a cable, which is plugged into theAED machine. Then bare the victim's chest including females and attach the adhesive AED

pads in the appropriate locations. The AED should include a diagram (typically on theadhesive pads themselves) indicating where each pad goes. The ZOLL AED uses a one-piecechest pad that makes placement easy.6. Always follow the instructions of the AED.

Note:CPR should not be interrupted while the adhesive electrode pads are beingapplied.

Analysing the victims heart rhythm.

The AED may instruct you to Stop CPR, do not touch patient, analysing. The rescuer willthen say "CLEAR!" to ensure that nobody is touching the victim while the AED analyses thevictims heart rhythm. A shock is only indicated if the victim's heart is in ventricular fibrillation(VF) or ventricular tachycardia (VT). The AED will automatically analyse the heart rhythm ofthe victim and inform you, the rescuer, whether a shock is advised.

If you get a "no shock advised" instruction from the AED it can mean:

the victim that you thought was pulse less does indeed have a pulse, or

the victim has now regained a pulse, or

the victim is pulseless but is not in a 'shockable' rhythm(i.e. not ventricular fibrillation (VT) or ventricular tachycardia (VT).


Delivering a shock to the victim.

If the AED indicates that a shock is required, make sure that everyone is CLEAR of thevictim. Tell everyone assisting you to stay clear of the victim and ensure that you are clear ofthe victim as well. Then press the shock button on the AED to deliver the first shock.Immediately following the shock, begin 2 minutes of CPR as instructed by the AED.

Perform CPR in cycles of 30 chest compressions to 2 breaths for 2 mins or until the AEDinforms you to "Stop CPR"

Note:D o n o t r e m o v e t h e A ED ch e s t p a d s w h i l e p e r fo r m i n g CPR.


Check the victim's rhythm.

After 2 minutes the AED will say Stop CPR, analysing The AED is now analysing the victim tosee whether a shockable rhythm is present and instruct you again either Shock advised or

No Shock advised, continue CPR in intervals of 2 mins or until help arrives.

If the AED gives a "no shock advised" message after any analysis, check the victim's pulseand breathing. If a pulse is present, monitor the victim's airway and provide assisted

breathing as needed.




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REFERENCES

Australian Resuscitation Council Guidelines, http://www.resus.org.au/

Deakin C et al (2010) European Resuscitation Council Guidelines for Resuscitation 2010.Section 3. Electrical therapies: Automated external defibrillators, defibrillation, cardioversionand pacing. Resuscitation; 81: 1293-1304.

Defibrillation and AED Use, Agilent Technologies

Defibrillation Training Course (Workbook), Surf Life Saving Australia (The life of the beach)Version 2, December 2003

Tortora, G.T and Grabowski, S.R. 1996 Principles of Anatomy and Physiology 8thEd. Sydney:

Harper Collins.

Jevon P (2009)Advanced Cardiac Life Support.Oxford: Wiley Blackwell.

Resuscitation Council (UK) (2011) Immediate Life Support. London: RCUK.

http://medlib.med.utah.edu/kw/ecg/image_index/index.html#Vtachy

http://medlib.med.utah.edu/kw/ecg/index.html

http://www.cc.utah.edu/~mda9899/CPRTable.html

http://www.resus.org.uk/pages/aed.pdf

SUGGESTED FURTHER READING:

Kenward, G., Castle, N. and Hodgetts, T.J. 2002 Should ward nurses be using automaticexternal defibrillators as first responders to improve the outcome from cardiac arrest? A

systematic review of the primary research. Resuscitationvol 52, issue 1, pp31-37

Resuscitation Council UK, The use of Automated External Defibrillatorshttp://www.resus.org.uk/pages/aed.pdf

Royal College of Nursing Australia 2006 Position Statement: The Role of Nurses in theManagement of Cardiorespiratory Arresthttp://www.rcna.org.au/UserFiles/role_of_nurses_in_the_management_of_cardio_respiratory

_arrest_revised_2006.pdfChan P et al (2008) Delayed time to defibrillation after in-hospital cardiac arrest. New England

Journal of Medicine; 358: 1, 9-17.

Deakin C et al (2010a) European Resuscitation Council Guidelines for Resuscitation 2010.Section 4. Adult advanced life support. Resuscitation; 81: 1305-1352.

Deakin C et al (2010b) European Resuscitation Council Guidelines for Resuscitation 2010Section 3. Electrical therapies: Automated external defibrillators, defibrillation, cardioversionand pacing. Resuscitation; 81: 1293-1304.

http://www.resus.org.au/http://medlib.med.utah.edu/kw/ecg/image_index/index.html#Vtachyhttp://medlib.med.utah.edu/kw/ecg/index.htmlhttp://www.cc.utah.edu/~mda9899/CPRTable.htmlhttp://www.resus.org.uk/pages/aed.pdfhttp://www.resus.org.uk/pages/aed.pdfhttp://www.rcna.org.au/UserFiles/role_of_nurses_in_the_management_of_cardio_respiratory_arrest_revised_2006.pdfhttp://www.rcna.org.au/UserFiles/role_of_nurses_in_the_management_of_cardio_respiratory_arrest_revised_2006.pdfhttp://www.rcna.org.au/UserFiles/role_of_nurses_in_the_management_of_cardio_respiratory_arrest_revised_2006.pdfhttp://www.rcna.org.au/UserFiles/role_of_nurses_in_the_management_of_cardio_respiratory_arrest_revised_2006.pdfhttp://www.resus.org.uk/pages/aed.pdfhttp://www.resus.org.uk/pages/aed.pdfhttp://www.cc.utah.edu/~mda9899/CPRTable.htmlhttp://medlib.med.utah.edu/kw/ecg/index.htmlhttp://medlib.med.utah.edu/kw/ecg/image_index/index.html#Vtachyhttp://www.resus.org.au/


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Gwinnutt C et al (2000) Outcome after cardiac arrest in adults in UK hospitals: effect of the1997 guidelines. Resuscitation; 47: 125-135.

Jevon P (2009)Advanced Cardiac Life Support. Oxford: Wiley Blackwell.

Resuscitation Council (UK) (2011) Immediate Life Support. London: RCUK.

Resuscitation Council (UK) (2010) Resuscitation Guidelines 2010. London: RCUK. tinyurl.com/resus-2010-guidelines

Spearpoint KG et al (2000) Early defibrillation and the chain of survival in in-hospital adultcardiac arrest: minutes count. Resuscitation; 44: 165-169.

Documents

Aed Guide Revision Feb 14 2012 Draft