Automatic External Defibrillator

Objectives for this subject - Why we use the AED? - How to use the AED? - Indications for the AED? - Contraindications to AED?

The chain of survival: - early access to 911 -early CPR -early defibrillation -early advanced care

Defibrillation is the application of electrical shock to help restore the heart’s regular rhythm

Defibrillator is the device used to deliver that shock and it can be manual or automatic.

Early defibrillation is the single most important factor in determining survival from cardiac arrest.

Defibrillation should be performed with in the first 8 minutes after cardiac arrest. Ideally, the sooner, the better.

AED Most common initial rhythms patients go into as they enter into cardiac arrest are:

“2 Shockable Rhythms” V-Tach and V-Fib

Ventricular Tachycardia: Fast heart rhythm which does not allow the heart to fill properly and cardiac output is compromised and reduced.

Ventricular Fibrillation: disorganized series of electrical discharges in the ventricles. Where the ventricles “quiver”.Stops Cardiac output and hearts pumping ability.

AED’s that are available are automatic and semi-automatic.

Automatic: where machine does all of the work Automatic: where machine does all of the work. Semi Automatic: where machine tells you when to push button to deliver shock.

Apply AED as soon as you determine that your patient is not breathing and does not have a pulse.

Always making sure that CPR is still in progress while you are setting up the AED. If by yourself, apply the AED.

Ensure before putting pads on chest, it is clear of all patches, paste or pacemakers. Don’t cover something up with pad.

If patient has hair on chest that could interfere with conduction, make sure you shave it off with razor provided to you.You want pads on chest to fit snug and secure.

“Red on Ribs! White on right!” Now attach the adhesive pads to the cables remembering- White is negative, anterior chest wall. Red is positive , left anterior axillary line. “Red on Ribs! White on right!”

Do Not Utilize The Anterior – Posterior (Front and Back) Lead Placement For Automatic Defibrillation

Now turn on machine and wait for AED to analyze the patients rhythm Now turn on machine and wait for AED to analyze the patients rhythm. Making sure that CPR has been stopped for machine to detect rhythm.

While waiting for machine, you can begin your patient information by speaking clearly into the tape recorder of the machine. You want to give certain information.

- Patients age. - Patients past medical history. - Patients medications. - Brief description of what happened prior to your arrival.

When machine advises a shock is indicated, ”CLEAR” your patient When machine advises a shock is indicated, ”CLEAR” your patient. Ensuring that no one is touching patient or stretcher.

When the AED delivers a shock it will go back and reanalyze the rhythm When the AED delivers a shock it will go back and reanalyze the rhythm. If another shock is appropriate “Clear Patient” and deliver the shock.

Sets of 3 shocks are called stacked shocks and they are done without any pauses to check patients pulse or administer CPR

If “No shock” is indicated: -Check breathing give appropriate oxygen therapy. -Check pulse, if no pulse! Start CPR for 1 minute and then have the AED reassess.

Transport patient when:. Patient regains a pulse Transport patient when: *Patient regains a pulse *Total of 6 shocks have been given. *AED has indicated 3 “no shocks”with intervening CPR.

Defibrillator Some ALS providers will choose to leave the AED in place Defibrillator Some ALS providers will choose to leave the AED in place. Some will choose to use their monitor for manual defibrillation.

Safety should always be maintained by the provider: -Not using near or around water -Ensuring all med patches and pastes are off the patient. -Making sure that everyone is clear of the patient when the shock is delivered.

Indications for AED * Unresponsive * Apneic * Pulseless patients.

Adult Patients > 8 years old > 55 lbs. Unresponsive,pulseless and apneic.

Contraindications: Infants and children < 8 years old < 55 lbs.

Contraindications: !! Hypothermia !! (Contact medical control)

Contraindications: Rigor / Livor Mortis No Code /DNR

The AED can’t properly analyze patient in moving ambulance The AED can’t properly analyze patient in moving ambulance. It is recommended that you stop the medic and let AED do it’s job.

Please review your Regional Medical Protocol Manual for further information