Automated External Defibrillation

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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, _______________________

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Emergency Cardiac Care “Chain of Survival”

Composed of 4 Links:

1. Early _______________________

2. Early _______________________

3. Early _______________________

4. Early _______________________ care

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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

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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

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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

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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

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Types of Defibrillators

3. _______________________ defibrillators• Every function is manually controlled• Requires extensive

_______________________ • Requires interpretation of

_______________________ • In the Pre-hospital setting, normally only used

by _______________________

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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

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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 _______________________

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Disadvantages to AEDs

• All _______________________ must be stopped

• Cost of units and supplies

• Requires continuing, _______________________ training

• Requires maintenance and periodic checks and tests

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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

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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

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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

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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

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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

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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

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EKG Rhythms

Normal Sinus Rhythm

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EKG Rhythms

Course Ventricular Fibrillation

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EKG Rhythms

Fine Ventricular Fibrillation

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EKG Rhythms

Ventricular Tachycardia

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EKG Rhythms

Asystole

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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.

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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

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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

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