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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?