1. VF treated with CPR and AED Ms. Lalith Sivanathan

2. Objectives Demonstrate the skills and sequence outlined in the BLS Healthcare providers algorithm Implement the BLS health care provider algorithm by performing 1 – rescuer CPR Implement the BLS healthcare provider algorithm by operating an AED

3. BLS Check responsiveness – Tap and shout, “Are you alright?” Check for absent or abnormal breathing (no breathing or only gasping) by looking at or scanning the chest for movement (about 5 to 10 secs) Activate emergency response system/ get AED

4. Circulation Check carotid pulse for 5 to 10 seconds If no pulse, start CPR (30:2) beginning with chest compressions Compress the centre of the chest (lower half of the sternum) hard and fast with at least 100 compressions per minute at a depth of at least 2 inches Allow complete recoil after each compressions per minute at the depth of 2 inches Allow complete chest recoil after each compression Minimize interruptions in compressions (10 sec or less) Switch providers about every 2 minutes to avoid fatigue Avoid excessive ventilation If there is pulse, start rescue breathing at 1 breath every 5 to 6 seconds (10 to 12 breaths per minute). Check pulse about every 2 mins

5. Defibrillation Purpose of defibrillation Defibrillation does not restart the heart. Defibrillation stuns the heart and briefly terminates all electrical activity, including VF, VT. If the heart is still viable, its normal pacemakers may eventually resume electrical activity ( return of spontaneous rhythm)

6. Use AED only if you have the following 3 clinical findings No response Absent or abnormal breathing (no breathing or only gasping) No pulse

7. Steps to use AED Power on the AED Attach electrode pads to the patient’s bare chest Choose correct size pads for the patient’s age. Peel backing away from the electrode pads Quickly wipe if the patient’s chest is covered with water or sweat Place one electrode on the upper side of the bare chest to the right of the sternum directly below the clavicle Place the other pad to the left of the nipple, with the top margin of the pad few inches below the left armpit Attach the AED connecting cables to the AED box

8. Analyze rhythm Clear the patient during analysis If AED advises shock, be sure to clear the patient (do not touch the patient) Press the shock button The shock will produce a sudden contraction of the patient’s muscles. Resume CPR, starting with chest compressions. After 2 mins the AED will prompt you to repeat analysis and shock if needed

9. Special situations Hairy chest The AED pads may stick to the hair and not to the skin on the chest, if this occurs, the AED will not properly analyze the rhythm, press down firmly on each pad, quickly pull off the pads, this would remove the hair, if too much hair remains, shave the area with razor in the AED case, if available Water pull the patient out of water and wipe the chest quickly before placing the electrodes Implanted pacemaker Place AED pads on the side and do not place on top of the device Transdermal medication patches Do not place AED electrodes directly on top of medication patch Remove the patch and wipe the area clean before attaching the electrodes

10. Thank you……..