1. ACA/NCCHC Credit: 1 Hour
Correctional Managed Care
Automated
External
Defibrillator
Copyright © UTMB 2009, All Rights Reserved
Revised 12/29/2009
ACA/NCCHC Credit: 1 Hour
ACA/NCCHC CREDIT: 1 HOUR

2. ACA/NCCHC Credit: 1 Hour
OBJECTIVES
Welcome to the computer based in-service on Automated External Defibrillators, also known as an AED. The sooner an AED is used on a victim of sudden cardiac arrest, the greater the chances of survival. The objectives for this program are to:
Describe the proper placement of the AED electrode pads.
List the four (4) universal steps of AED operation.
Describe three (3) situations for which special precautions should be taken before using the AED.
ACA/NCCHC Credit: 1 Hour

3. ACA/NCCHC Credit: 1 Hour
DEFIBRILLATION
Most often, sudden cardiac arrest is caused by an abnormal heart rhythm called Ventricular Fibrillation (VF) that prevents the heart from pumping blood. The treatment for VF is defibrillation.
Defibrillation is the delivery of an electric shock to the heart that stops VF and allows a normal heart rhythm to resume.
Defibrillation is the most effective treatment for VF. It is most likely to be successful if it occurs within minutes of the cardiac arrest and may be ineffective if delayed. This process is performed with a computerized device known as an AED or Automated External Defibrillator.
ACA/NCCHC Credit: 1 Hour

4. ACA/NCCHC Credit: 1 Hour
AED
AED defibrillators were designed to function easily, be
dependable, and be utilized with a minimal amount of
training. An AED analyzes the rate, size and pattern of a
heart rhythm, and is known to be very accurate when
used on adult victims. If an AED is not immediately
available, CPR protocol should be initiated until an
AED arrives at the scene. The availability of the AED
device is becoming more common throughout many
communities. Facilities such as airports, recreational
complexes and shopping malls are providing easy access
to AED devices.
ACA/NCCHC Credit: 1 Hour

5. ACA/NCCHC Credit: 1 Hour
FUNCTIONS OF AN AED
What are the functions of an AED?
Automatically analyzes heart rhythms.
Determines whether defibrillation is advised.
Guides the rescuer through the defibrillation.
Follows comprehensive “self-checking” protocols.
Prompts the rescuer to begin/resume CPR.
ACA/NCCHC Credit: 1 Hour

6. ACA/NCCHC Credit: 1 Hour
USE OF AN AED
You should attach the AED electrode pads only to a victim in cardiac arrest.
Before attaching an AED, confirm that these three (3) signs of cardiac arrest are present:
No response
No adequate breathing
(A victim in cardiac arrest may demonstrate agonal gasps. These gasping breaths are not effective breathing. A victim who has agonal gasps, does not respond, and has no pulse is in cardiac arrest.)
No pulse
ACA/NCCHC Credit: 1 Hour

7. SPECIAL CONDITIONS CONCERNING AEDs (CHILDREN) ACA/NCCHC Credit: 1 Hour
The AEDs utilized within UTMB-CMC have been approved for use only in victims 8 years old and older. The electrical energy (shock) settings of AEDs are often too high for children less than 8 years old.
What to Do:
If the victim is less than 8 years old, do not use the AED. Perform CPR until EMS or trained personnel arrive with a defibrillator capable of delivering small energy shocks.
ACA/NCCHC Credit: 1 Hour

8. SPECIAL CONDITIONS CONCERNING AEDs (WATER) ACA/NCCHC Credit: 1 Hour
Shocking a victim who is in water, covered with water, or sweat, or lying on a wet surface may cause burns or shocks to the victim or rescuers or prevent delivery of the shock to the victim’s heart.
What to Do:
Remove the victim from contact with water, and dry the victim’s chest before you attach the AED.
ACA/NCCHC Credit: 1 Hour

9. ACA/NCCHC Credit: 1 Hour
SPECIAL CONDITIONS CONCERNING AEDs (IMPLANTED PACEMAKERS/DEFIBRILLATORS)
Implanted pacemakers or defibrillators:
These devices are implanted in the upper part of the chest or abdomen (usually on the victim’s left side). The device creates a hard lump beneath the skin. The lump is about half the size of a deck of cards. The victim will usually have a small scar. Placing an electrode pad over an implanted device will reduce the effectiveness of the shock.
What to Do:
Do not place an AED electrode pad over an implanted device, but place it at least 1 inch to the side of the device.
ACA/NCCHC Credit: 1 Hour

10. ACA/NCCHC Credit: 1 Hour
SPECIAL CONDITIONS CONCERNING AEDs (TRANSDERMAL MEDICATION PATCH/OTHER OBJECT)
Transdermal medication patch or other object:
Placing an AED electrode pad on top of a medication patch or other object will prevent delivery of shocks or cause small burns to the skin.
What to Do:
Instead, remove the medication patch or other object and wipe the area clean before attaching the AED electrode pads.
ACA/NCCHC Credit: 1 Hour

11. SPECIAL CONDITIONS CONCERNING AEDs (HAIRY CHEST)
Extremely Hairy Chest:
Placing an AED electrode pad over hair may also reduce the effectiveness of the shock.
What to Do:
You may need to quickly shave the victim’s chest prior to attaching the AED electrode pads.
ACA/NCCHC Credit: 1 Hour

12. ACA/NCCHC Credit: 1 Hour
UNRESPONSIVE?
Check unresponsiveness: Tap the victim and shout, “Are you OK?”
If the victim does not respond: Yell for help.
If someone comes, send that person to phone EMS (911) and get the AED.
If no one comes, leave the victim to phone EMS (911) or the emergency response phone number and get the AED, if available. Return to the victim, after phoning EMS (911), and begin the steps of CPR.
ACA/NCCHC Credit: 1 Hour

13. ACA/NCCHC Credit: 1 Hour
CARDIAC ARREST
The 3 signs of cardiac arrest in adults are:
If the victim has these 3 signs, begin CPR (chest compressions with rescue breathing) and use the AED, if available.
No response
No adequate breathing
No pulse
ACA/NCCHC Credit: 1 Hour

14. THE CPR – AED PROTOCOL (ABCD) ACA/NCCHC Credit: 1 Hour
Once you verify the victim is unresponsive, phone EMS (911)
and get the AED. Then begin the CPR – AED protocol.
A: AIRWAY: Open the airway. Use the head tilt-chin lift or jaw thrust.
B: BREATHING: Look, listen, and feel for breathing. If no adequate breathing, give 2 breaths.
C: CIRCULATION: Check for pulse. If no pulse, begin chest compressions.
D: DEFIBRILLATION: The 4 universal steps of AED operation follows.
ACA/NCCHC Credit: 1 Hour

15. ACA/NCCHC Credit: 1 Hour
AED PREPARATION
An AED is equipped with three (3) parts, these parts are as follows:
Electrode Pads
The AED unit
The Electrode Pads
The Connecting Cables
AED
Connecting Cables
**Ensure that all parts are connected correctly prior to use.
ACA/NCCHC Credit: 1 Hour

16. ACA/NCCHC Credit: 1 Hour
AED OPERATION
There are four universal steps of AED Operation:
POWER ON the AED.
ATTACH electrode pads to the victim’s bare chest.
“CLEAR” the victim and ANALYZE heart rhythm.
If AED advises a shock “CLEAR” the victim and deliver a SHOCK.
ACA/NCCHC Credit: 1 Hour

17. ACA/NCCHC Credit: 1 Hour
1. POWER ON THE AED.
First, to operate an AED you must turn on power to the AED. Open the carrying case or the top of the AED. Turn the power on (some devices will “power on” automatically when you open the lid or case). This will start the voice prompts that guide you through the process of using the AED.
ACA/NCCHC Credit: 1 Hour

18. ACA/NCCHC Credit: 1 Hour
2. ATTACH ELECTRODE PADS
Secondly, you should open the electrode package and remove the adhesive backing from the electrode pads. Attach the pads directly to the victim’s bare chest using the following directions.
Place the Right Electrode Pad:
On the upper-right side of the bare chest.
To the right of the breast bone.
Directly below the collar bone, and above the right nipple.
ACA/NCCHC Credit: 1 Hour

19. 2. ATTACH ELECTRODE PADS (cont.) ACA/NCCHC Credit: 1 Hour
Place the Left Electrode Pad:
A few inches below the left armpit.
After Electrode Pads have been placed on victim, plug in the AED electrode pads connector cable to the AED (some are pre-connected).
ACA/NCCHC Credit: 1 Hour

20. 3. CLEAR THE VICTIM AND ANALYZE HEART RHYTHM ACA/NCCHC Credit: 1 Hour
Some AED models require you to press a button to begin the process of analysis of the heart rhythm. Some AED models may automatically start to analyze the victim as soon as the electrode pads are in place.
Before the analysis begins, you should take charge and ensure that no one is touching the victim. This “clearing” process starts with you saying LOUDLY, “I’m Clear, You’re Clear, Everyone’s Clear”, while doing a visual inspection that no one is touching the victim prior to pressing the button to begin analysis.
ACA/NCCHC Credit: 1 Hour

21. ACA/NCCHC Credit: 1 Hour
ANALYSIS
If the victim remains still and no one moves the victim, the analysis takes approximately 5 to 15 seconds to complete the check. If the victim is on a stretcher while en route, it may be necessary to stop all movement and ensure that no one is touching the victim or the stretcher during the analysis. If the AED indicates the VF heart rhythm, it will communicate that the victim needs to be shocked.
ACA/NCCHC Credit: 1 Hour

22. ACA/NCCHC Credit: 1 Hour
“NO SHOCK INDICATED”
If or when the AED tells you that there is “no shock indicated,” you will then need to follow the directions below:
Check pulse for signs of circulation.
If none are present, resume CPR for 1 minute.
If none present the 2nd time, clear victim and analyze heart rhythm again.
ACA/NCCHC Credit: 1 Hour

23. “NO SHOCK INDICATED” (cont.) ACA/NCCHC Credit: 1 Hour
After following the previous steps, and…
“No shock indicated” X 3
Resume CPR
And no pulse is present
Analyze rhythm every 1-2 minutes
ACA/NCCHC Credit: 1 Hour

24. 4. CLEAR THE VICTIM AND SHOCK
If the AED gives a “shock indicated” or “shock advised” message, it is extremely important to “clear” the victim prior to shock. Do this by following the same method used prior for the heart rhythm analysis ensuring that NO ONE is touching the victim, LOUDLY repeat the “clear” statement…
“I’m Clear, You’re Clear, Everyone’s Clear”
Do not continue to shock the victim if anyone is touching the victim. Do a visual inspection to ensure that no one is touching the victim.
ACA/NCCHC Credit: 1 Hour

25. ACA/NCCHC Credit: 1 Hour
“SHOCK INDICATED”
All AEDs must charge before they can deliver a shock, although some charge automatically. Your AED may require you to press a CHARGE button prior to delivering the shock. These models will have a separate button to press to deliver the actual SHOCK. If the victim is on a stretcher while en route, it may be necessary to stop all movement and ensure that no one is touching the victim or the stretcher prior to delivering the shock. After receiving a shock, the victim’s muscles will suddenly contract.
ACA/NCCHC Credit: 1 Hour

26. ACA/NCCHC Credit: 1 Hour
WHAT HAPPENS NEXT?
After the first shock, the AED should re-check the heart rhythm. You may need to “clear” the victim and press the button again to analyze. It is important that no one touch the victim directly after the shock to allow the AED to analyze the victim a second time. If defibrillation is not successful another shock is warranted. This complete process is repeated for only 3 sequences.
*IMPORTANT:
If after three (3) shocks, and no pulse is present, you should begin CPR for one (1) minute. Then attempt additional AED sequences of analysis and shocks. This process will continue after each sequence of three (3) shocks.
ACA/NCCHC Credit: 1 Hour

27. ACA/NCCHC Credit: 1 Hour
MAKING IT SIMPLE
Analyze
1st Shock
1 minute of CPR
Rhythm Analysis
Rhythm Analysis
3rd Shock (if indicated)
2nd Shock (if indicated)
Rhythm Analysis
ACA/NCCHC Credit: 1 Hour

28. ACA/NCCHC Credit: 1 Hour
SUCCESSFUL DEFIBRILLATION
When the AED indicates that “no shock is advised” and signs of circulation and breathing return, you should:
Place victim in a recovery position
Leave all of the equipment attached and in the “on” mode
Continue to monitor the victim
Frequently check that signs of circulation are maintained until qualified help arrives.
ACA/NCCHC Credit: 1 Hour

29. ACA/NCCHC Credit: 1 Hour
AED MAINTENANCE
You should follow the facility policy on AED system checks, readiness checks, and electrode expiration date checks. Please refer to the “Manufacturer’s Guide” for specific instructions for your AED model. AED malfunctions are rare. Most AED “problems” are caused by operator error or failure to perform recommended user-based maintenance. You should also:
Become familiar with your AED and how it operates.
Check the AED for visible problems such as signs of damage.
Perform all user-based maintenance according to the manufacturer’s recommendations.
Prepare a fully stocked AED carrying case.
ACA/NCCHC Credit: 1 Hour

30. ACA/NCCHC Credit: 1 Hour
AED CARRYING CASE SUPPLIES
It is the facility staff’s responsibility to prepare an AED carrying case containing the following items:
2 sets of extra electrode pads (3 sets total)
2 pocket face masks
2 extra batteries (if appropriate for your AED; some AEDs have batteries that last for years)
2 disposable razors
5-10 alcohol pads
5 sterile gauze pads (4X4 inches), individually wrapped
1 absorbent cloth towel
ACA/NCCHC Credit: 1 Hour

31. ACA/NCCHC Credit: 1 Hour
REFERENCES
The AHA’s (American Heart Association) Web site provide answers to frequently asked questions about the Automated External Defibrillator (
ACA/NCCHC Credit: 1 Hour

32. ACA/NCCHC Credit: 1 Hour
You have completed this program.
Click on the “Complete Course”
button then continue to the
evaluation and exam.
ACA/NCCHC Credit: 1 Hour