Download Pediatric Pads - The Loudoun County Volunteer Rescue Squad

Loudoun County AED
Program
AED
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Rev. 11/2013
Objectives
Identify
Properly
the function and anatomy of the heart
operate the AED
Integrate
Identify
AED into CPR/scene management
any special circumstances that impact AED use
Maintaining
and identifying problems associated with the AED
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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.”
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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.
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Electrical Pathway
• Sinoatrial Node (SA)
• Atrioventricular Node
(AV)
• Bundle of His
• Bundle Branches
• Purkinje Fibers
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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!
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Shockable Rhythms
• 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).
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Shockable Rhythms
Ventricular
Fibrillation
Pulseless
Ventricular
Tachycardia
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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.
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AEDs used by Loudoun County Fire
& Rescue Companies
Lifepak 1000
Lifepak 12
All units are biphasic
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Lifepak 15
AED Components/Accessories

Battery

Microprocessor/Charging Unit

Pads & Cables

Extra pads

Razor

Wash cloth

Spare batteries & Paper (for LP 12/15)
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Laerdal Heart Stream
Purcellville Town Administration
Middleburg Town and Police
Found in Purcellville Police vehicles
.
Pads are not compatible with Medtronic (Lifepak) units
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Authorized Use of AED
• Granted to locally authorized EMR, EMT, EMT-I, AEMT, Paramedic
• Active member of OEMS EMS Licensed Agency authorized to operate
in Loudoun County
• Current BLS – AHA Healthcare Provider
• Recertification every 12 months
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Indications for Use
•Standing Order – Cardiac Arrest
Pulseless and Apneic
Regardless of age (from birth)
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Definitive Signs of Death (DOA)
• Criteria
Decomposition
Lividity or dependent pooling of blood
Obvious mortal injury that is inconsistent with life
Rigor mortis
Presence of a valid Virginia Durable Do Not
Resuscitate (DDNR) order
• If in doubt, begin resuscitation and contact
medical control for guidance
•
•
•
•
•
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Scene Safety/BSI
 Make sure that the environment is safe.
 Is the patient lying in water?
 Do you need to move the patient before
starting care?
 It is not safe to defibrillate in a moving
ambulance!
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Initial Assessment

Level of Consciousness



Circulation

Check pulse

Begin CPR with 30 chest compressions
Airway


After 30 compressions, open Airway
Breathing


Check for signs of life (breathing, chest rise)
Deliver 2 breaths using BVM/Pocket Mask
Continue CPR until AED arrives
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AED Operations
 CPR should be started immediately
 On arrival of the AED, attach pads and turn it on
 Do NOT delay AED implementation.
 AHA CPR no longer treats witnessed –v- unwitnessed
arrest differently
 Continue CPR until AED arrives then analyze
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Attach AED to Patient
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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.
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Electrode Placement
Correct electrode position optimizes the amount
of current flowing through the ventricles
Correct electrode position
Incorrect electrode position
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Effective Adherence of Pads
• Sweaty chest
• Dry with a towel
• Do not use alcohol
• Hairy chest
• Shaving may be needed
• Ultimate goal is to have
complete skin contact.
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Current AED Programming
• Loudoun County AED’s are setup to prompt
witnessed or unwitnessed arrest instructions
• If the AED asks if you witnessed the arrest, push
‘CANCEL’
• This means that the AED has detected a
shockable rhythm
• If the AED doesn’t ask, then continue CPR as
directed by the AED
• This means that the AED has detected a nonshockable rhythm
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After pushing cancel, clear patient in
preparation for a shock
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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”
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Shockable Rhythm
AED “Shock
Advised”
CPR
2
minutes
• If a “Shockable Rhythm” presents (and
continues to be present), administer a total
of 3 shocks. Each single shock is separated
AED “Shock
Advised”
CPR
2
minutes
by 2 minutes of CPR
• Pulse Checks are to be performed when the
AED “Shock
Advised”
AED indicates.
CPR
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Check Pulse Contact
Medical Control
,Prepare to
transport
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“No Shock Advised”
• If “No Shock is Advised”, perform two minutes
of CPR , and listen for re-analyze prompt
•
If three “No Shocks” occur (separated by two
minutes of CPR each time), contact Medical
Control.
• Remember “no shock advised” does not mean
there is a pulse.
• Pulse Checks are ONLY to be performed when
the AED indicates
AED
“No Shock
Advised”
CPR
2
minutes
AED
“No Shocked
Advised”
CPR
2
minutes
AED
“No Shock
Advised”
CPR
Contact Med
Control, Prepare
to Transport
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If you do get a pulse,
• Assess the quality of the pulse.
• Assess and/or support breathing.
• Check the patient’s blood pressure.
• Do not turn off the AED or remove pads.
• Contact medical control.
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Call Medical Control &
Prepare to Transport …..
Three (3) shocks total delivered
OR
Three (3) “No Shock Advised”
OR
Patient regains a Pulse!
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While enroute ...
If patient loses pulse enroute:
Stop vehicle, analyze rhythm:
If shock is advised:
Deliver shocks, if indicated.
Follow protocol.
If maximum shocks reached contact Medical Control
for further orders.
If no shock is advised:
Begin CPR
Follow protocols
Advise Medical Control and continue transport as may be
indicated.
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Documentation
•Field Bridge
• Report assessment findings
• Complete AED usage section
•Make sure all fields are completed as
appropriate
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Special Situations
• Medication patches
• Artificial pacemakers or Automated internal
cardiac defibrillators (AICDs)
• Traumatic arrests
• Pediatrics
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Medication Patches
 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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Artificial Pacemakers
• Pulse generator and wires
to the heart.
• Usually found on the left
side of the chest.
• If found on the right, do not
place the pad over the
pacemaker.
• A direct shock to the
pacemaker could cause it to
reprogram.
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Automated Internal Cardiac
Defibrillator (AICD)
• Used in patients with
recurrent arrhythmias
• If found on the right,
do not place the pad
on the AICD
• Its presence does not
preclude attaching
and using an AED
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Trauma & Obvious Death
• AED should not be attached to a patient that is
obviously dead.
• Signs incompatible with life, e.g. rigor mortis, etc.
• Signs of injuries incompatible with life, e.g.
decapitation
• AED may be attached to a trauma patient in
cardiac arrest since the cardiac arrest may have
caused the trauma.
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Pediatric Patients
• AED’s should be used on any patient in
cardiac arrest of ANY age.
• Adults include adolescents (i.e. after the
onset of puberty)
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Pediatric Patient
• Use the Lifepak1000 with
adult pads on adolescents or
more than 55 lbs (25kg)
• Use the Lifepak1000 with
Pediatric Reduced Energy
Defibrillation
pads/electrodes on children
55 lbs (25kg) or less.
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Pediatric Patient
• With Pediatric pads/electrodes, energy from
the Lifepak 1000 is reduced by a factor of 4
• Approximately 50-75-86 Joules is delivered if
the Lifepak 1000 is set at 200-300-360
Joules
Attenuated (reduced
energy) Pediatric Pads
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Pediatric Patient
• Pediatric pads supplied for the LP1000 are
not compatible with the LP12 or 15.
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Pediatric Patient
• Place the Pediatric pads
in the sternum-apex
position (same location
as adult pads)
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Anterior/Posterior Position
• May be used if:
• Using adult pads on a pediatric patient because no
pediatric pads are available
• Child is small and pads will be within 1” of each
other in sternum/apex position
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LP 1000 Battery
• The Lifepak 1000 is powered by a nonrechargeable lithium manganese dioxide
battery pack
• Battery pack fuel gauge indicates battery’s
charge level
• Fully charged battery: all green lights
illuminated
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LP 1000 Battery
• Low battery: single
steady green light
• Empty battery: single
flashing green light
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LP 1000 Battery
• The approximate level of charge in the battery
appears on the readiness display when the
Lifepak 1000 is off
• Battery low: battery symbol has one bar
• Battery empty: battery symbol has no bars
• When indicating ‘LOW’, battery should not be
changed in the middle of a call
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LP 12 and 15 Batteries
The LP 12 and 15 batteries are powered by a lithium ion
battery that is rechargeable
Battery fuel gauge indicates battery’s charge level
Fully charged battery: all green lights illuminated
Can be replaced when low (one at a time), and when
replaced will not interrupt the operation of the AED
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Troubleshooting Tips
• Message: “Connect electrodes”
“Check connector and electrodes”
• Possible causes:
• Electrodes are not adhered to the patient’s skin
• Electrodes are disconnected
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Troubleshooting Tips
• Message: “Connect electrodes”
“Check connector and electrodes”
• What to do
• 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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Troubleshooting Tips
• Message: “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:
•
•
•
•
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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Troubleshooting Tips
• Message: “Replace battery”
• Possible causes:
• Battery pack 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
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Maintenance
• Daily Auto Test (LP 1000 only)
• The Lifepak1000 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
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Maintenance
• Self-test
• Each time the Lifepak 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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Maintenance
• If the Lifepak 1000 requires service, the
wrench symbol appears
• If the wrench is visible, remove the
Lifepak 1000 from service and contact
authorized service personnel
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After-use Care
After the AED has been used:
•
•
•
•
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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Routine Maintenance
• On a periodic basis check the following:
OK symbol/battery gauge level is visible on LP1000
Battery gauge level on LP 12/15
Use-by date on electrode pads is 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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Questions or
Comments?
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