Download AED - The Loudoun County Volunteer Rescue Squad

Loudoun County AED Program
AED
Rev. Dec 12
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Objectives
•Identify the function and anatomy of the heart
•Properly operate the AED
•Integrate AED into CPR/scene management
•Identify any special circumstances that impact AED use
•Maintaining and identifying problems associated with the AED
Rev. Dec 12
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Definition
“Defibrillation is the delivery of an electric
current through the chest wall and heart
for the purpose of terminating ventricular
fibrillation or pulseless ventricular
tachycardia and restoring a perfusing
rhythm.”
Rev. Dec 12
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A & P of the Heart
A network of specialized tissue, capable of
conducting electrical current, runs throughout
the heart muscle.
As electrical impulses travel through this
network, coordinated contractions of the heart
muscle occur.
Rev. Dec 12
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Electrical Pathway

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Sinoatrial Node (SA)
Atrioventricular Node
(AV)
Bundle of His
Bundle Branches
Purkinje Fibers
Rev. Dec 12
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Heart Function

Electrical



Electrical impulses
through the heart.
Evaluated with ECG
monitor.

Mechanical


Actual pumping of the
heart.
Evaluated by checking
pulse.
An electrical rhythm
does not mean there is
a pulse!
Rev. Dec 12
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Shockable Rhythms

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Pulseless Ventricular Tachycardia (VT) may be the initial
rhythm for a patient in cardiac arrest.
Ventricular Fibrillation (VFib) is the most frequent rhythm
present when a patient is found in cardiac arrest.
Ventricular Fibrillation is a useless quivering of the heart
that results in no blood flow, therefore no pulse.
Early Defibrillation is the only effective treatment for
Ventricular Fibrillation.
AEDs shock Pulseless Ventricular Tachycardia (VT) and
Ventricular Fibrillation (VFib).
Rev. Dec 12
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Shockable Rhythms
Ventricular
Fibrillation
Pulseless
Ventricular
Tachycardia
Rev. Dec 12
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The absence of any electrical impulse is called
Asystole
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AEDs and Ventricular Fibrillation/
Pulseless Ventricular Tachycardia

Defibrillation “shocks” the heart in an effort to restore
normal electrical activity of the heart.

Defibrillation is the only effective treatment for
VF/Pulseless VT, once the patient’s pump has been
primed

The ability to successfully defibrillate a patient into a
normal rhythm diminishes rapidly over time.
Rev. Dec 12
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AEDs used by Loudoun County Fire
& Rescue Companies
Lifepak 1000
Rev. Dec 12
Lifepak 15
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Lifepak 12
11
AED Components/Accessories

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AED with Battery
Pediatric and Adult Pads
Razor
Wash cloth
Spare batteries & Paper
(for LP 12 only)
Rev. Dec 12
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Authorized Use of AED

Granted to locally authorized FR, EMT, Advanced
EMT, I/P

Active member of OEMS EMS Licensed Agency
authorized to operate in Loudoun County

Current BLS – AHA Healthcare Provider

Recertification every 12 months
Rev. Dec 12
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Indications for Use
 Standing
Order – Cardiac Arrest
Pulseless and Apneic of any age
Rev. Oct 09
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Presumptive Death (DOA)

Criteria
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Decomposition
Lividity or dependent pooling of blood
Obvious mortal injury that is inconsistent with
life
Rigor mortis
Presence of a Virginia Durable Do Not
Resuscitate (DDNR) order
If in doubt, begin resuscitation and contact
medical control for guidance
Rev. Dec 12
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Scene Safety/BSI

Make sure that the environment is safe.

Is the patient laying in water?


Do you need to move the patient before
starting care?
It is not safe to defibrillate in a moving
ambulance!
Rev. Decd 12
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CPR Procedure
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Patient is found pulseless and apneic or
unresponsive:
Procedures:
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Rev. Dec 12
Look for signs of breathing…if none
perform a pulse check for 5-10 seconds, if
no pulse start CPR w/ compressions
Perform CPR while attaching AED patches
Turn on AED and analyze rhythm
immediately
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Two Possible Scenarios

Shockable Rhythm
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After shock, immediately resume CPR
Switch providers for compressions along with
analyzing
Must have 3 consecutive prior to transport
Non-shockable Rhythm

Must have 3 consecutive prior to transport
Rev. June 08
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“I’m Clear”
“You’re Clear”
“Everybody is Clear”
While visually checking to make sure that no one
is touching patient!
“Shocking Now”
Rev. Dec 12
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Attaching AED to Patient
Rev. Dec 12
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Effective Adherence of Pads

Sweaty chest
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Dry with a towel
Do not use alcohol
Hairy chest

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Shaving may be needed
Ultimate goal is to have
complete skin contact.
Rev. Dec 12
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Sternum-Apex Position
Sternum:
Right Pad is placed below
the right clavicle and to the
right of the Sternum above
the nipple.
Apex:
Left Pad is placed on the
lower left ribs in the
midaxillary line.
Rev. Dec 12
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Electrode Placement
Correct electrode position optimizes the amount
of current flowing through the ventricles
Correct electrode position
Rev. Dec 12
Incorrect electrode position
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Pediatric Patient


Use the AED1000 with adult
pads on children older than
8 years old or more than 55
lbs (25kg)
Use the AED 1000 with
Pediatric Reduced Energy
Defibrillation Pads on
children 1 to 8 years old or
55 lbs (25kg) or less.
Rev. Dec 12
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Pediatric Patient


With Pediatric Pads, energy from the AED
1000 is reduced by a factor of 4
Approximately 50-75-86 Joules is
delivered if the AED1000 is set at 200300-360 Joules
Attenuated (reduced
energy) Pediatric Pads
Rev. Dec 12
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Pediatric Patient

Pediatric pads supplied for the LP1000 are
not compatible with the LP12 or 15.
Rev. Dec 12
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Pediatric Patient

Place the Pediatric
pads in the anteriorlateral position (same
locations has adult
pads)
Rev. Oct 09
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Anterior/Posterior Position

May be used if:


Rev. Dec 12
Adult pads on a pediatric patient if no pediatric
pads are avail
Child is small and pads will be within 1” of each
other
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Medtronic
LifePak 12 or 15
Rev. Oct 09
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After confirming a Cardiac
Arrest turn AED on
CONNECT ELECTRODES message
and voice prompt occur until the patient
is connected to the therapy cables
Clear patient than push analyze button
Rev. Dec 12
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Do not touch or move the patient or therapy cables during analysis.
The AED requires 6-9 seconds to fully analyze the patient’s rhythm
Allow machine to complete the analysis
Never override the machine
Rev. Dec 12
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Allow machine to charge
Do not over ride system
Say “I’m clear”
“Your clear”
“Everyone’s clear”
“Shocking now”
Prior to pushing the shock button
Rev. Dec 12
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Lifepak has identifies an non-shockable rhythm
Check carotid artery
AED will count down 2 minutes of CPR
Do not override the countdown
Push Analyze when prompted
Rev. Oct 09
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Medtronic
Lifepak 1000
Rev. Dec 12
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Lifepak 1000 Operations
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Confirm Cardiac Arrest
Turn on AED
Attach Pads
AED will immediately began to analyze
If AED detects a shockable rhythm machine will
ask “If you witnessed the arrest push cancel”
If AED has detected a non-shockable rhythm no
prompt will be given start CPR for 2 minutes
Follow prompts of the machine
Rev. Dec 12
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Check for Pulse
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You may be prompted to check for a
pulse after a no shock advised decision.
YES and NO soft keys appear on the
screen
If patient does not have a pulse, press
the NO soft key and CPR time begins
If patient has pulse, press the YES soft
key The 1000 will prompt the user to
provide rescue breaths, if needed
The 1000 enters continuous monitoring
state
Rev. Dec 12
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If you do get a pulse,

Assess the quality of the pulse.
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Assess and/or support breathing.
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Check the patient’s blood pressure.
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Do not turn off the AED or remove pads.
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Contact medical control.
Rev. Dec 12
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Call Medical Control &
Prepare to Transport …..
Maximum of 3 shocks with 2
minutes of CPR between
shocks are delivered*.
Three (3) “No Shock Advised”
scenarios
Patient regains a Pulse!
Rev. Dec 12
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While enroute ...
If patient loses a pulse enroute…
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Rev. Dec 12
STOP AMBULANCE
Reanalyze
Continue with procedures as usual
Contact receiving hospital with updated
information
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Documentation
 Electronic


Report assessment findings
Complete AED usage section
 Code
Rev. Dec 12
PPCR –
summary (LP12).
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Special
Situations
Rev. June 08
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Special Situations
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Medication patches
Artificial pacemakers
Automated internal cardiac defibrillators
(AICDs)
Traumatic arrests
Rev. Oct 09
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Medication Patches
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Rev. Dec 12
Aluminum backing or the
medium is reactive.
Patch either heats up or
ignites.
Expose the patient and
remove ALL patches
before defibrillation.
Wipe any medication off
the chest.
Use gloves when you
remove it.
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Automated Internal Cardiac
Defibrillator (AICD)

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
Rev. Oct 09
In patients with
recurrent
arrhythmias.
If found on the right
Do not place the pad
on the AICD.
It’s presence does not
preclude attaching
and using an AED.
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Artificial Pacemakers
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Pulse generator and wires
to the heart.
Usually found on the left
side of the cheat.
If found on the right Do
not place the pad over
the pacemaker.
A direct shock to the
pacemaker could cause it
to reprogram.
Rev. Dec 12
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Trauma & Obvious Death

AED should not be attached to a patient that
is obviously dead.

Signs of incompatible with life, e.g., rigor
mortis, etc.


Signs of injuries incompatible with life
AED may be attached to a trauma patient in
cardiac arrest since the cardiac arrest may
have caused the trauma.
Rev. Dec 12
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Batteries of the AED
Rev. Dec 12
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LP 1000 Battery



The 1000 is powered by a nonrechargeable
lithium manganese dioxide battery pak
Battery pak fuel gauge indicates battery’s
charge level
Fully charged battery: all green lights
illuminated
Rev. Dec 12
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LP 1000 Battery
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
Low battery: single
steady green light
Empty battery:
single flashing
green light
Rev. Dec 12
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LP 1000 Battery
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The approximate level of charge in the battery
appears on the readiness display when the
1000 is off
Battery low: battery symbol has one bar
Battery empty: battery symbol has no bars
When low it cannot be replaced on the scene
Rev. Dec 12
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LP 12 and 15 Batteries
The LP 12 and 15 Batteries are powered by lithium ion
battery pak and are rechargeable
Battery pak fuel gauge indicates battery’s charge level
Fully charged battery: all green lights illuminated
Can be replaced when low and will not interrupt the
operation of the AED
Rev. Dec 12
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Troubleshooting and
Maintenance
of the AED
Rev. Dec 12
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“Connect Electrodes” Message

Possible causes:
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Electrodes are not adhered to the patient’s skin
Electrodes are disconnected
What to do
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Rev. Dec 12
Firmly press electrode onto the skin
Check to be sure connector is
completely inserted into the AED
Clean, shave and dry the skin
Replace the electrode pads
If prompt continues, perform CPR until ALS arrives
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Motion detected, stop motion”

Possible causes:


Patient movement due to: breathing, CPR being
performed during analysis, some internal
pacemakers, vehicle motion, or electrical/radio
frequency interference
What to do:

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Rev. Oct 09
Check patient for normal breathing
Stop CPR during analysis
Stop vehicle during analysis
Move communication or other suspected
devices away from AED when possible
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“Replace Battery”

Possible causes:
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Battery pak has exceeded specified
“on time” and/or energy discharges
What to do:


LP 1000 Continue to use during resuscitation
LP 12/15 Obtain a replacement battery
Rev. Dec 12
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Maintenance Symbol


Rev. Oct 09
If the 1000 requires service, the wrench
symbol appears
If the wrench is visible, remove the
1000 from service and contact
authorized
service personnel
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Maintenance

Daily Auto Test (LP 1000 only)
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The 1000 performs automatic tests
daily at 3:00 AM
OK symbol visible: AED is ready for use
Daily Auto Test will test for low or replace
battery conditions
Battery gauge on the readiness display
updates every day
Rev. Oct 09
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Maintenance

Self-test



Rev. Oct 09
Each time the 1000 is manually turned on, it
performs internal self-tests to check that the
internal electrical components and circuits
work properly
Also indicates a low or replace battery
condition
LP 12/15 does not provide this option
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Routine Maintenance

On a periodic basis check the following:


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
Dev. Oct 09
OK symbol is visible on LP1000
Battery gauge level on LP 12/15
Use-by date on electrode pads has not
passed
Other emergency supplies stored with the
unit are present (e.g., face masks, gloves,
razors, etc.)
Damage to or foreign substances
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Recommended Corrective Actions

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Wrench symbol visible: contact authorized
service personnel
Battery symbol visible: replace if low
battery indicated
Use-by date passed: replace electrode packet
Supplies missing: replenish as needed
Damage noted: contact authorized
service personnel
Foreign substance visible: clean with damp
sponge or cloth with recommended cleaning
agents
Rev. Oct 09
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After-use Care
After the AED has been used:

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Rev. Dec 12
Clean off foreign substances
Replace electrodes
Replenish supplies as needed
Check battery symbol for battery status
and replace battery if low
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Review Questions
Rev. Dec 12
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Disorganized twitching of the
ventricle in which no blood
goes to the body is called:
Ventricular Fibrillation
Rev. Dec 12
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What age range does the
Semi-Automated External
Defibrillation (AED) protocol
allow the cardiac arrest
patient to be treated with an
AED?
Patients who appear to be
one (1) year of age or
older
Rev. Dec 12
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Prior to ceasing resuscitation
methods all providers will contact
the appropriate LHC-Med Control.
What are the two instances when
immediate contact should be made?
Valid DNR is discovered after CPR has begun
• Injuries/circumstances preclude the safe continuation
of CPR efforts
•
Rev. Dec 12
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When using the LP 1000, after
one shock with the AED, your
next step is to __________.
Start CPR/2 minutes of CPR
Rev. Dec 12
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Before delivering a shock, you
must say, “________” while
looking around the patient.
I’m clear, your clear, we
are all clear…
Shocking now.
Rev. Dec 12
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When Should the AnteriorPosterior Pad Placement Site be
Utilized?
If the electrodes touch in
the sternum-apex position
Rev. Dec 12
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The absence of any electrical
rhythm in the heart is called
___________.
Asystole
Rev. Dec 12
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As a First Responder,
EMT/AET/I/P in Loudoun
County, you are granted
STANDING ORDERS to deliver
______ total shocks.
3
Rev. Dec 12
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Does Hypothermia, overdose
and/or drowning effect how a
resuscitation is performed?
Yes
If may prolong the efforts and should be made
identified to Medical Control early in the
resuscitation.
Rev. Dec 12
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71
In a witnessed cardiac arrest
if you had a choice between
initiating CPR or connecting
the AED, which should you do
first?
Attach the AED and follow
the prompts
Rev. Dec 12
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Are the pediatric AED
electrodes used in a Lifepak
1000 the same as those used
by a medic operating a
Lifepak 12?
No
They are not compatible, and when an ALS
provides arrives they will need to replace the
pads from the Lifepak 1000 with their
Lifepak 12 pediatric pads
Rev. Dec 12
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The primary locations for the
placement of the electrodes of the
AED on an adult patient is
___ and _____.
Apex and Sternum
Rev. Dec 12
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What is age range to consider
using pediatric pads?
Intended for use on children 1 to 8
years of age or up to 25kg (55lb).
Rev. Dec 12
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One of three things must
occur which trigger contacting
Medical Control and preparing
to transport the patient
connected to the AED. They
are:
3 shocks are given
3 consecutive no-shock advised
Return of spontaneous pulse
Rev. Dec 12
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You are transporting a patient
in the ambulance when the
patient collapses into cardiac
arrest. What do you do?
Stop the ambulance, start CPR,
attach the AED, and initiate
rhythm analysis
Rev. Dec 12
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A patient for whom
resuscitative measures have
been terminated should be
transported to which facility?
LHC- Cornwall or
LHC –Lansdowne ER
If ALS procedures have been performed the ALSAIC shall accompany the body to the ER
Rev. Dec 12
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You arrive to assist a patient in
cardiac arrest who has an
Automatic Implanted Cardiac
Defibrillator (AICD).
What should you do?
Attach AED and proceed as
normal attempting to avoid the
AICD.
Rev.. Dec 12
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The sternum pad is placed just
below the right _____
clavicle
Rev. Dec 12
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A 25 year old man is found lying in
water on the deck of a backyard
pool. He is unresponsive, not
breathing, and pulseless. CPR is
being performed as you prepare to
use an AED. What should be the
next steps?
Remove the patient from the water, wipe the chest
dry and then attach the AED pads firmly to the chest
*Remember the provider scene safety, and to assure
they are not standing in water nor the patient lying in
a puddle of water.
Rev. Dec 12
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Questions or Comments?
Rev. Dec 12
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