1. AUTOMATED EXTERNAL DEFIBRILLATION
LESSON 9
AUTOMATED EXTERNAL DEFIBRILLATION

2. 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

3. 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

4. Heart’s Electrical System

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

6. 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

7. 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

8. 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%

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

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

19. Skill: AED

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

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

22. Apply pads to chest

23. Stand clear during rhythm analysis

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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

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

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

33. 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

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