Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 9 Automated External Defibrillation

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Topics About Defibrillation Operating a Defibrillator

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ About Defibrillation

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ About Defibrillation What is an AED? –Electric shock applied to the chest –Automated external defibrillator Interprets heart rhythm Delivers shock through pads Requirements Medical director Quality improvement Continuing education

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ About Defibrillation Types of AEDs –Fully automated Does everything once turned on and pads are attached –Semi-automated Operator controls the analyze and shock features

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ About Defibrillation Types of AEDs –Components Power switch Analyze button Shock button Data recorder

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ About Defibrillation

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ About Defibrillation Types of AEDs –Monophasic Delivers shocks at 360 J –Biphasic Delivers more exact dose of electricity Based on thickness and electrical resistance of chest

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Heart rhythms Operating guidelines Post-resuscitation care Call review AED maintenance

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Follow protocols Do not touch patient during analysis or shock phases Do not apply AED to a patient with a pulse Can be used on patients > 1 year with pediatric defibrillator pads

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Heart rhythms –Shockable rhythms Ventricular fibrillation

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Heart rhythms –Shockable rhythms Ventricular tachycardia

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Heart rhythms Nonshockable rhythms Pulseless electrical activity Asystole

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Operating guidelines –Witnessed cardiac arrest Down time less than 4–5 minutes Apply AED immediately

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Operating guidelines –Unwitnessed cardiac arrest Down time more than 5 minutes Perform CPR for 5 cycles Apply AED

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Operating guidelines –Applying adhesive pads Place one pad inferior to the right clavicle Place one pad over the patient’s left, lower, lateral rib cage

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Operating guidelines –Applying adhesive pads Do not place pads over nitroglycerin patches Do not position over a pacemaker Shave the patient’s chest if it is hairy

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Operating guidelines –Operating the AED Stop CPR Confirm that the patient is pulseless Attach pads Turn AED on Clear all providers Press analyze

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Operating guidelines –Operating the AED If no shock advised Check pulse Continue CPR if necessary

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Operating guidelines –Operating the AED If shock advised Clear everyone Deliver shock Check pulse Continue CPR if necessary for 1 minute Reanalyze and shock as directed

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Operating guidelines –Operating the AED If alone with unresponsive patient Witnessed collapse Apply AED immediately if available

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Operating guidelines –Operating the AED If alone with unresponsive patient Unwitnessed collapse CPR for 5 cycles Apply AED

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Post-resuscitation care –Monitor pulse carefully –Ventilate as necessary –Place in recovery position with pulse and adequate breathing –Apply oxygen –Keep AED attached –Continue assessment

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator Call review –After AED use Review by quality improvement Recommendations for improvement

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Operating a Defibrillator AED maintenance –Self-check feature –Make sure of the following: Batteries well charged Pads and cables with AED Disposable razors available

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Summary AED use is a vital link in the AHA Chain of Survival AEDs can be used on anyone over 1 year old CPR only buys time until analyzing and shocking a patient Begin CPR following a pulse check, immediately following defibrillation