AUTOMATED EXTERNAL DEFIBRILLATION LESSON 9 AUTOMATED EXTERNAL DEFIBRILLATION

Introduction Many patients receiving CPR benefit from an AED Abnormal heart rhythm can be corrected with AED shock Use AED with unresponsive, non-breathing and pulseless patients CPR keeps patient viable until AED shock restores normal heart rhythm

AEDs, Medical Direction and Laws Medical director oversees placement and use of AED Many AED units in public places and homes Safe to use by lay rescuers AED technology continues to evolve, making them easier and safer to use

Heart’s Electrical System

Heart’s Electrical System (continued) System keeps contractions of 4 chambers of heart synchronized With heart attack (or other problems), rhythmic electrical control disrupted

Ventricular Fibrillation Ventricular Fibrillation (VF) is most common abnormal heart rhythm Ventricles of heart quiver instead of beating rhythmically In about ½ of cases of cardiac arrest, patient’s heart is in VF

How AEDs Work Automatically checks patient’s heart rhythm to detect fibrillation Advises whether patient needs a shock The shock (defibrillation) may return heart to a more normal rhythm

Time is Important AEDs are easy and simple to use but must be used right away With every minute that goes by, chances for survival drop by 10%

The AED Unit Contains a battery and is portable Unit has 2 pads connected to it with 1 or 2 cables Pads are placed on patient’s chest (or as directed in an infant or small child) Unit analyzes patient’s heart and advises whether to give a shock

Using an AED Whenever patient suddenly collapses or is found unresponsive, consider possibility of cardiac arrest  send someone for AED 9-1-1 dispatcher may alert rescuers to nearby AED

AED and CPR Check patient for normal breathing and a pulse Use AED as soon as available if patient is unresponsive, not breathing normally and pulseless With two rescuers, one gives CPR and one sets up AED For non-breathing infant or child found unresponsive (not observed to have collapsed suddenly), give 5 cycles of CPR before using the AED

Attach AED to Patient Be sure patient is not in water or in contact with metal Place AED near patient’s shoulder and turn it on Attach pads to patient’s chest See diagram on pads On adult or large child: One on right side below collar bone One below and to left of left nipple On infant or small child: Apply as directed by unit’s diagram

Attach AED to Patient (continued) Attach pads to patient only if patient is unresponsive, not breathing normally and pulseless Expose patient’s chest and dry or shave it if needed Remove backing from pads and apply firmly on patient’s chest (or chest and back in infant or small child) If required with AED model, plug pad cables into main unit

Analyze and Shock Most AEDs automatically analyze patient’s heart rhythm Do not move or touch patient while it is analyzing Unit will advise shock or to resume CPR Follow unit’s prompts

Analyze and Shock (continued) If shock advised: Be sure no one is touching patient Administer shock (or stay clear as unit automatically gives the shock) Immediately resume 5 cycles CPR (~2 minutes) AED will analyze and advise again

Different AEDs May Use Different Prompts Follow unit’s voice and visual prompts Some units are programmed to administer shock automatically; follow unit’s prompts Some units provide feedback about CPR skills between shocks

If the Patient Recovers Put unresponsive, breathing patient in HAINES recovery position if spinal injury is not suspected Continue to monitor breathing Keep AED pads in place because some patients return to VF and require defibrillation again

If the AED Says No Shock Patient’s heart will not benefit from defibrillation Immediately resume CPR

Skill: AED

Position patient away from water and metal Place unit by patient’s shoulder and turn it on

Expose patient’s chest Dry or shave pad placement areas as necessary

Apply pads to chest

Stand clear during rhythm analysis

Follow prompts to: (1) give shock (2) stay clear during automatic shock or (3) do not give shock but resume CPR

Stand clear when AED prompts to analyze rhythm again after 5 cycles of CPR (about two minutes) Continue until patient wakes up or more advanced help arrives and takes over If patient begins breathing normally but is unresponsive, put in recovery position (with pads in place) and continue to monitor breathing and pulse

AED Alerts Remove any medication pads present with a gloved hand Avoid flammable materials, including oxygen flowing through a mask Don’t use alcohol to wipe patient’s skin Don’t use AED when in motion Don’t use cell phone or two-way radio within 6 feet of AED Don’t touch patient while AED is analyzing the rhythm or administering a shock  except as advised by the AED

AED Use in Infants and Children Follow adult guidelines for children >8 years Sudden cardiac arrest can occur in infants and children as result of: SIDS Poisoning Drowning Heart problems

AED Use in Infants and Children (continued) Give infant or child two minutes of CPR before using AED – unless witnessed that infant or child collapsed suddenly

Pediatric AED Pads Use pediatric pads: Smaller Produce lower-energy shocks Follow diagram on pads for placement Use adult pads if pediatric pads are not available Pediatric pads should not be used on adults

Changing AED Technology AED technology continues to evolve Some units use same pads for all patients – have a separate switch on unit for pediatric patients Always follow AED prompts

Special AED Considerations – Internal Pacemaker or Defibrillator Vary AED placement if there is an internal device

Special AED Considerations – Medication Patches Remove medication patches prior to pad placement

Potential AED Problems AED must be maintained regularly and have charged battery AED may prompt you to avoid problems With low battery prompt, change battery before continuing May get prompt to avoid moving patient Error message may indicate pads not firmly in contact with patient’s skin

AED Maintenance AEDs require regular maintenance Check manufacturer’s manual Daily inspection ensures AED ready for use and supplies are present