Download The Defibrillation Process

Defibrillator Training
PUAOPE010B- Operate a Semi Automatic Defibrillator in an
Emergency
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Version 2, August 2008
© Life Saving Victoria
Agenda
Defibrillator Training
Section 1)
 Leading Causes of Death in Australia.
 Chain of Survival.
 CPR review.
Section 2)
 Mechanical and Electrical Action of the Heart.
 Cardio Rhythm and Arrhythmias
 Types of SAED
 The Defibrillation Process
 Defibrillation Safety
Section 3)
 Assessment
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Defibrillator Training
Cardiac Arrest
• In 2006 there were 133,739 reported deaths in
Australia, of which:
‘Ischaemic heart diseases accounted for 22,983 deaths
in Australia.’
http://www.aihw.gov.au/cvd/majordiseases/coronary.cfm
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Defibrillator Training
Cardiac Arrest
Q) Why is Defibrillation important?
A) ‘It make up an important part of the
Chain of survival?’
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Defibrillator Training
Chain of Survival
Early Access
‘Avoids delay in obtaining assistance’
 Cause/recognition of Cardiac Arrest
 Scene Survey
 Primary Survey
 Calling for Help
Early CPR
‘Buys time’
 Extends duration of ventricular
fibrillation
 Keeps vital organs oxygenated
delays irreversible brain
damage
Early Access ...
‘000’
… to get help
Early CPR...
… to buy time
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Defibrillator Training
Chain of Survival
Early Defibrillation
‘Increases sudden Cardiac Arrest victim survival chances’
Early Defibrillation ...
 Re-establishes normal
rhythm in the heart
 Combined with Early
CPR allows victim best
survival chance
… to restart heart
Early Advanced Care (Life Support)
‘Treatment by Medical Personnel/
Paramedics’
 Beyond scope of First Responders
 More effective if previous three
links are completed early/effectively
Early Advanced Care ...
… to stablize
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Defibrillator Training
Why?
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Defibrillator Training
Chain of Survival
CPR Review Activity
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Defibrillator Training
Action Plan
ARC Action Plan
D anger
R esponse
A irway
B reathing
C ompressions
D efibrillation
Chain of Survival
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Defibrillator Training
Legal Considerations
Four main legal considerations relating to
first aid:
duty of care
negligence
consent
recording
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Defibrillator Training
The Heart
Actions of the heart
Mechanical action:
 Pumping of the heart.
Electrical action:
 controls the rhythmic beat of the
heart.
The electrical impulse passing through
the heart muscle can be mapped on a
graph called an electrocardiogram (ECG)
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Defibrillator Training
Mechanical Action
Right Atrium
‘Receives Blood from Body and
blood is then pumped into’
Right Ventricle
‘Blood is then Pumps Blood to
the Lungs’
Left Atrium
‘Receives Blood from Lungs and
pumps blood into
Left Ventricle
Pumps Blood to the Body
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Defibrillator Training
The Electrocardiogram
The Electrical Action of the Heart
The normal pathway of electrical impulse
through the heart is:
SA (Sinoatrial) Node – pacemaker
AV (Atrioventricular) Node
Normal Heart Rates:
Children 70-120 beats/min
Adults 60-100 beats/min
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Defibrillator Training
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Defibrillator Training
Defibrillator Training
Cardiac Arrest
This can occur as a result of,
• Lack of oxygen to the heart and brain through drowning or near
drowning.
• Disruption to the heart’s normal electrical activity due to
electrocution.
• Mass blood loss resulting in a loss of blood pressure and thus
oxygen to the heart muscles.
• Heart Attack due to a complete or partial blockage of a Coronary
Artery that supplies blood to the heart. For example, an Acute
Myocardial Infarction (AMI).
http://www.heartfoundation.org.au/Heart_Information/Adult_Conditions/Heart_Attack.htm
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Defibrillator Training
Why use a SAED?
An Semi-Automatic External Defibrillator (SAED) is:
A portable device
Able to recognise shockable rhythms in a patient in cardiac
arrest
Able to deliver an electrical shock to revert the heart back
to its normal rhythm
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Non-Shockable Cardiac Rhythms
Defibrillator Training
Sinus Rhythm:
Sinus rhythm is the normal rhythm of a healthy heart
SAED will not recommend, nor allow, a shock if normal sinus rhythm is
detected
Asystole:
There is very minimal electrical activity during ventricular
asystole, but no contraction of the heart muscle and,
consequently, no pulse. CPR is the only treatment, SAED will
not recommend a shock if this rhythm is detected
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Shockable Heart Arrhythmias
Defibrillator Training
Ventricular tachycardia (VT): (rapid, ineffective)
Heart beats so fast that little or no pulse is generated.
Life threatening as it inhibits effective distribution of oxygenated blood.
Symptoms
 Very rapid pulse, or no cardiac
output.
 Unconsciousness
No Breathing
Treatment
DRABC- CPR if not breathing.
Attach Defibrillator and follow
instructions.
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Shockable Heart Arrhythmias
Defibrillator Training
Ventricular Tachycardia (VT)
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Shockable Heart Arrhythmias
Defibrillator Training
Ventricular fibrillation (VF): (fluttering, quivering)
Electrical activity is uncoordinated and chaotic.
Ventricles cannot pump blood throughout body resulting in no cardiac
output (no pulse).
This is life-threatening and results in collapse with cardiac arrest
Signs
Loss of consciousness
No breathing, no “signs of
life”
Treatment
DRABC
Defibrillation
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Shockable Heart Arrhythmias
Defibrillator Training
Ventricular Fibrillation (VF)
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Defibrillator Training
S.A.E.D
How does the defibrillator work?
‘Charge goes from one pad to the other and then returns.’
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Defibrillator Training
The Defibrillation Process
Indications for use of SAED:
The patient is unresponsive
The patient is not breathing and has no “signs of life”
The first aider has access to the SAED and is trained in the use
of SAED (recommended)
When connected, the SAED will:
1.Give instructions to the user
2.Analyze patient’s cardiac electrical activity
3.Advise user of action:
 Deliver Shock or Recommence CPR.
*Important- The ARC recommends SAEDs are only to be used
on patients over 8 years or 25kg.
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Defibrillator Training
The Defibrillation Process
Positioning of electrode pads
Place Sternum electrode pad to the right of
the sternum (breastbone) below the
collarbone and above the right nipple
Place the Apex electrode pad to the left of
the sternum, with upper edge of pad below
and to the left of the nipple
Do not remove electrodes after
pulse returns.
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Defibrillator Training
The Defibrillation Process
Effective adherence of electrode pads
 Only place electrode pads on clean, dry skin
 Do not use alcohol wipes
 If chest is hairy, remove hair with shears
 Apply electrode pads with a
smooth rolling action to
prevent air bubbles
 Once applied, electrode
pads should not be
repositioned or removed
 Do not use electrodes after
their expiry date
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Defibrillation Safety
Defibrillator Training
Safety Considerations:
 Remove any metallic jewellery near the electrode sites
 Make sure pads are at least 10cm away from an implanted
pacemaker
 Do not place pads over medication patches
 Avoid contact between electrodes and metal surfaces
 Do not operate SAED in a moving or explosive environment
as this may effect the ECG analysis.
 Patient should be dry and clear of water.
 Oxygen approx. 1m from patient.
 Use only equipment that is compatible with the unit
 Do not operate the unit in close proximity to mobile phones,
radios etc
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Defibrillation Safety
Defibrillator Training
Most Important……..
Do not make contact with patient during shock delivery
to prevent harm to rescuer. To help you remember this
when unit advises shock say the following out loud.
“I’m clear, you’re clear, everybody’s clear”
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Troubleshooting
Defibrillator Training
 Damaged pads
 Replace pads
 Pads not firmly attached
 Press firmly on pads
 Cable not correctly plugged in
 Ensure cable is fully inserted
 Victim’s chest isn’t dry or is excessively hairy
 Wipe chest dry or clip hair
 Analysis interrupted by moving or touching the victim
 Don’t touch victim, stop movement, restart analysis
 Interference from radios or mobile phones
 Keep at least 2m from AED
 Battery is low
 Replace battery
If unit is not working, revert back to DRABCD and
continue with CPR.
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Natoli, D., & Lippmann, J. (2002). Automated External Defibrillators. Melbourne: J.L.Publications
Defibrillator Training
SAED kit requirements
Defibrillator
Spare battery (if applicable)
Resuscitation masks
Space blanket
Gloves
Pen and paper
Shears
Chamois or towel
Gauze wipes (or similar)
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Defibrillator Training
Equipment Maintenance
Where should the unit be stored?
 Usually in a dry stable environment. Refer to user guide.
What needs to be done post incident?
 Equipment check, disposable items replaced. Refer to user
guide.
Minor Faults and Repair
 Charge – battery replacement.
 Electrode pads – date and still sealed.
 Other minor faults as per manufacturer guidelines.
Major fault reporting
 Recorded in log book
 Relevant person notified for immediate repair
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Defibrillator Training
Reporting
After an incident, it is advised that you report
everything you did.
Ambulance Officers or Paramedics may also
request a report.
Under the OH&S Act, reports of all incidences at
the workplace should be recorded.
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Defibrillator Training
F.A.Q.
•
‘Can you defibrillate a pregnant woman?’
•
‘Can you defibrillate a wet person?’
•
‘What if I am not sure they need Defibrillation?’
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