1. A LWTC/NSCC presentation
EMT Defibrillation
A LWTC/NSCC presentation

3. Objectives
Understand cardiac arrest physiology and impact CPR/AED has on patient outcomes
Demonstrate knowledge and understanding of AED use in role as the EMT/Defib Tech in cardiac arrest

4. Some Statistics
Seattle-King County EMS agencies responded to 1035 cardiac arrest patients in 2007
302 (29%) of these patients initially presented in VF/VT
Survival rate (post VF arrest) for Seattle-King County is 45%
Seattle-King County post VF survival rates have increased from less than 16% in the early 1980’s (no early CPR, early defib, ALS) to a high of 45% in This successful rate can be directly attributed to early recognition of cardiac arrest and initiation of CPR, early delivery of defibrillatory shock by PAD/AED, and BLS/ALS intervention. This is the highest rate in the nation with some EMS systems posting post arrest survival rates of less than 5%.

5. Goals
Quality CPR is to be performed and interrupted for a minimal amount of time
VF/VT to be shocked as soon as defibrillator is available
Overall patient care and safety are never to be neglected
Stress the importance of quality CPR as the underlying foundation for success with early defibrillation. Past cardiac arrest studies have shown that by performing quality, uninterrupted CPR compressions the heart (in VF/VT) basically is “primed” to receive a defibrillatory shock. This shock allows the intrinsic pacemaker of the heart to “kick back in” in order to effectively circulate oxygenated blood to the brain thus improving neurological outcome post cardiac arrest.

6. Your Goal…

7. Basic Cardiac Physiology

8. Normal Cardiac Conduction
Electrical pattern
ECG tracing
Explain the cardiac conduction pathways with the electrical impulse originating in the SA node (right atrium) which travels to the AV node (division of the right and left ventricles), down along the right and left bundle branches to the Purkinje fibers.
Intrinsic heart rates at the SA node are 80 bpm, the AV node is 60 bpm, and the ventricular rate (Purkinje fibers) is 40 bom.

9. Cardiac Arrest Occulsion of the coronary artery leads to ischemia
Ischemia leads to infarct which causes interruption of normal cardiac conduction
Infarct = VF/VT

10. Shockable Rhythms Ventricular Fibrillation Ventricular Tachycardia
Goal is to initiate quality, uninterrupted CPR and initiated defib procedures to deliver a shock to these shockable rhythms.

11. Defib Procedure

12. Equipment AED is capable of analyzing shockable rhythms
Delivers biphasic shock ( joules)
Can be used for pediatric pts (< 8) with adult/pediatric pads

13. Defibrillation Basics
Shockable rhythm is defined as VF or unconscious/pulseless VT.
CPR must be performed with minimal interruptions except in cases of airway management (aspiration of emesis)

14. Defibrillation Basics
Before the AED can be turned on the patient must be:
Unconscious
Unresponsive
Apneic
Pulseless

15. Defib Procedure Check for consciousness/responsiveness.
Access ABCs. If not breathing, open airway & begin ventilations.
Check pulse. If pulse not present, initiate CPR.
Turn on defibrillator, apply pads, begin verbal report.
Allow defibrillator to analyze (stop CPR)

16. Pad Placement
Pad placement critical for effective delivery of biphasic shock. Key is to minimize impedance from bone (clavicle, sternum, ribs) and allow maximum energy delivery to heart. Defib tech must be able to place pads without interfering with CPR.

17. …non-shockable rhythm and deliver command to resume CPR
AED will analyze…
…shockable rhythm of VF/pulseless VT and deliver command to deliver shock OR
…non-shockable rhythm and deliver command to resume CPR

18. Shock Advised (VF or VT)
Clear patient from head to toe (SAFETY!)
Deliver single shock
Immediately begin CPR and continue for 2 minutes.
Do not delay CPR for pulse check or post-shock rhythm analysis.

19. Shock Advised (VF or VT)
After 2 minutes of CPR, analyze rhythm (stop CPR)
No pulse check required
If shock is indicated, clear patient, and deliver 2nd shock.
Continue uninterrupted CPR for 2 minutes

20. Shock Advised (VF or VT)
After 2 minutes of CPR, analyze rhythm (stop CPR)
No pulse check required
If shock is indicated, clear patient, and deliver 3rd shock.
Continue uninterrupted CPR for 2 minutes.

21. Shock Advised (VF or VT)
After 2 minutes of CPR, analyze rhythm (stop CPR)
No pulse check required
If shock is indicated, clear patient, and deliver shock.
Continue uninterrupted CPR for 2 minutes.
Continue process until Medic arrival

22. No Shock Advised Immediately begin CPR
Continue uninterrupted CPR for 2 minutes
Do not delay CPR for pulse check

23. No Shock Advised After 2 minutes of CPR, analyze rhythm (stop CPR)
Do not check pulse before analyzing rhythm
If No Shock is advised, check pulse.
No pulse, continue uninterrupted CPR for 2 minutes

24. No Shock Advised
If pulse is present after pulse check, obtain patient’s blood pressure, check airway to ensure it is clear, and assess breathing for adequate breathing.
Assist ventilations if inadequate.
If blood pressure < 60 mmHg systolic, perform uninterrupted CPR for 2 minutes

25. No Shock Advised After 2 minutes of CPR, analyze patient (stop CPR)
Do not check pulse before analyzing rhythm
If No Shock advised, check pulse.
If no pulse, continue uninterrupted CPR for 2 minutes
After 3rd No Shock, continue CPR without analyzing patient

26. Safety

27. Safety Defib tech is in charge at ALL times!
You are responsible for the overall quality of airway management, CPR, and safe, effective defibrillation
Be sure to clear patient from head-to-toe prior to delivering shock

28. Special Circumstances
Pediatric patients (< 1 year old)
Trauma patients
Hypothermia
Pediatric patients (< 1 year old): CPR until ALS arrives or patient begins to move
Trauma patients: cardiac arrest in trauma is most likely secondary to traumatic injury/blood loss. Definitive care is rapid transport to appropriate trauma center and immediate surgery.
Hypothermic patient (unconscious/unresponsive/apneic/pulseless): a single AED shock is to be deliver after initial rhythm analysis with uninterrupted CPR following.

29. Questions?