Download Chapter 17 Cardiac Emergencies

Chapter 17
Cardiac Emergencies
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
U.S. DOT Objectives Directory
U.S. DOT Objectives are covered and/or supported by the PowerPoint™ Slide
Program and Notes for Emergency Care, 11th Ed. Please see the Chapter 17
correlation below.
*KNOWLEDGE AND ATTITUDE
• 4-3.1 Describe the structure and function of the cardiovascular system.
Slides 10-16
• 4-3.2 Describe the emergency medical care of the patient experiencing chest
pain or discomfort. Slides 30-41, 43
• 4-3.3 List the indications for automated external defibrillation (AED). Slides 55,
57, 59
• 4-3.4 List the contraindications for automated external defibrillation. Slides 56,
58, 65, 69
• 4-3.5 Define the role of EMT in the emergency cardiac care system. Slides 3092
• 4-3.6 Explain the impact of age and weight on defibrillation. Slide 86
• 4-3.7 Discuss the position of comfort for patients with various cardiac
emergencies. Slide 31
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
U.S. DOT Objectives Directory
*KNOWLEDGE AND ATTITUDE
• 4-3.8 Establish the relationship between airway management and the patient
with cardiovascular compromise. Slides 50, 73, 82, 86
• 4-3.9 Predict the relationship between the patient experiencing cardiovascular
compromise and basic life support. Slides 41-50
• 4-3.10 Discuss the fundamentals of early defibrillation. Slides 44, 47
• 4-3.11 Explain the rationale for early defibrillation. Slides 44, 47
• 4-3.12 Explain that not all chest pain patients result in cardiac arrest and do not
need to be attached to an automated external defibrillator. Slide 43
• 4-3.13 Explain the importance of prehospital ACLS intervention if it is available.
Slide 48
• 4-3.14 Explain the importance of urgent transport to a facility with advanced
cardiac life support if it is not available in the prehospital setting. Slides 33-34
• 4-3.15 Discuss the various types of automated external defibrillators. Slides 5354
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
U.S. DOT Objectives Directory
*KNOWLEDGE AND ATTITUDE
• 4-3.16 Differentiate between the fully automated and the semiautomated
defibrillator. Slide 53
• 4-3.17 Discuss the procedures that must be taken into consideration for
standard operations of the various types of automated external defibrillators.
Slides 55-79
• 4-3.18 State the reasons for assuring that the patient is pulseless and apneic
when using the automated external defibrillator. Slide 59
• 4-3.19 Discuss the circumstances which may result in inappropriate shocks.
Slide 56
• 4-3.20 Explain the considerations for interruption of CPR when using the
automated external defibrillator. Slides 60-62, 77
• 4-3.21 Discuss the advantages and disadvantages of automated external
defibrillators. Slide 53
• 4-3.22 Summarize the speed of operation of automated external defibrillation.
Slide 53
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
U.S. DOT Objectives Directory
*KNOWLEDGE AND ATTITUDE
• 4-3.23 Discuss the use of remote defibrillation through adhesive pads. Slide 54
• 4-3.24 Discuss the special considerations for rhythm monitoring. Slides 57-58
• 4-3.25 List the steps in the operation of the automated external defibrillator.
Slides 64-76
• 4-3.26 Discuss the standard of care that should be used to provide care to a
patient with persistent ventricular fibrillation and no available ACLS. Slides 51-88
• 4-3.27 Discuss the standard of care that should be used to provide care to a
patient with recurrent ventricular fibrillation and no available ACLS. Slides 51-88
• 4-3.28 Differentiate between single rescuer and multi-rescuer care with an
automated external defibrillator. Slide 85
• 4-3.29 Explain the reason for pulses not being checked between shocks with an
automated external defibrillator.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
U.S. DOT Objectives Directory
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*KNOWLEDGE AND ATTITUDE
• 4-3.30 Discuss the importance of coordinating ACLS trained providers with
personnel using automated external defibrillators. Slides 80-81
• 4-3.31 Discuss the importance of post-resuscitation care. Slides 82-84
• 4-3.32 List the components of post-resuscitation care. Slides 82-84
• 4-3.33 Explain the importance of frequent practice with the automated external
defibrillator. Slide 92
• 4-3.34 Discuss the need to complete the Automated Defibrillator: Operator’s
Shift Checklist. Slide 91
• 4-3.35 Discuss the role of the American Heart Association (AHA) in the use of
automated external defibrillation. Slide 44
• 4-3.36 Explain the role medical direction plays in the use of automated external
defibrillation. Slide 92
• 4-3.37 State the reasons why a case review should be completed following the
use of the automated external defibrillator. Slide 92
• 4-3.38 Discuss the components that should be included in a case review. Slide
92
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
U.S. DOT Objectives Directory
*KNOWLEDGE AND ATTITUDE
• 4-3.39 Discuss the goal of quality improvement in automated external
defibrillation. Slide 92
• 4-3.40 Recognize the need for medical direction of protocols to assist in the
emergency medical care of the patient with chest pain. Slides 35-36, 38-40, 92
• 4-3.41 List the indications for the use of nitroglycerin. Slides 36-37
• 4-3.42 State the contraindications and side effects for the use of nitroglycerin.
Slides 36-37
• 4-3.43 Define the function of all controls on an automated external defibrillator,
and describe event documentation and battery defibrillator maintenance. Slides
67, 70-71, 74
• 4-3.44 Defend the reasons for obtaining initial training in automated external
defibrillation and the importance of continuing education. Slide 92
• 4-3.45 Defend the reason for maintenance of automated external defibrillators.
Slide 91
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
U.S. DOT Objectives Directory
*KNOWLEDGE AND ATTITUDE
• 4-3.46 Explain the rationale for administering nitroglycerin to a patient with chest
pain or discomfort. Slides 35-40
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
U.S. DOT Objectives Directory
*SKILLS
• 4-3.47 Demonstrate the assessment and emergency medical
• care of a patient experiencing chest pain or discomfort.
• 4-3.48 Demonstrate the application and operation of the automated external
defibrillator.
• 4-3.49 Demonstrate the maintenance of an automated external defibrillator.
• 4-3.50 Demonstrate the assessment and documentation of patient response to
the automated external defibrillator.
• 4-3.51 Demonstrate the skills necessary to complete the Automated Defibrillator:
Operator’s Shift Checklist.
• 4-3.52 Perform the steps in facilitating the use of nitroglycerin for chest pain or
discomfort.
• 4-3.53 Demonstrate the assessment and documentation of patient response to
nitroglycerin.
• 4-3.54 Practice completing a prehospital care report for patients with cardiac
emergencies.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Virtual Tours and Animations
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Click here to view a virtual tour of the respiratory system.
Click here to view a virtual tour of the heart.
Click here to view a virtual tour of the head and neck.
Click here to view a virtual tour of the trunk and abdomen.
Click here to view an animation of the heart.
Click here to view an animation of cardiovascular emergencies.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Review of
Circulatory System
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Cross-Section of the Heart
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
The Four Chambers of the Heart
Right Atrium
Left Atrium
Receives blood from
veins; pumps to right
ventricle.
Receives blood from
lungs; pumps to left
ventricle.
Right Ventricle
Left Ventricle
Pumps blood to the
lungs.
Pumps blood through
the aorta to the body.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Cardiac Conduction System
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
The Coronary Arteries
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Vessels of Circulation
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Cardiac
Compromise
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Causes of Cardiac Compromise
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Causes of Cardiac Compromise
Aneurysms
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Causes of Cardiac Compromise
Electrical Malfunctions of the Heart
Bradycardia
– Less than 60 beats per minute
Tachycardia
– Greater than 100 beats per minute
No pulse
– Cardiac arrest
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Causes of Cardiac Compromise
Mechanical Malfunctions of the Heart
This can lead to cardiac arrest,
shock, pulmonary edema (fluids
“backing up” in the lungs), or
congestive heart failure.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Causes of Cardiac Compromise
Angina Pectoris
Coronary arteries
Partial blockage
producing chest pain
Area of decreased
blood supply
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Causes of Cardiac Compromise
Angina Pectoris
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Click here to view an animation on angina pectoris.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Causes of Cardiac Compromise
Acute Myocardial Infarction
Area of Infarct
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Limmer et al., Emergency Care, 11th Edition
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Causes of Cardiac Compromise
Myocardial infarction or ventricular
weakening causes blood back-up to
the lungs with fluid accumulation.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Causes of Cardiac Compromise
Congestive Heart Failure
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Symptoms of Cardiac
Compromise
Chest Pain
Discomfort in chest or upper abdomen
–
Pain, pressure, crushing, squeezing,
heaviness
Palpitation/fluttering
May radiate down one or both arms
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Signs and Symptoms of
Cardiac Compromise
Difficulty breathing (dyspnea)
Nausea, vomiting
Anxiety/feeling of impending doom
The elderly, diabetics, and female
patients may not experience chest pain
or discomfort in cardiac compromise.
Weakness and difficulty breathing are
more common symptoms.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Signs and Symptoms of
Cardiac Compromise
Cool, pale skin
Dizziness
Sweating
Abnormal heart rates
–Tachycardia—faster than 100 bpm
–Bradycardia—slower than 60 bpm
Abnormal blood pressures
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Perform a Complete Initial
Assessment
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Place Patient in Position of Comfort;
Give High-Concentration Oxygen by
Nonrebreather Mask
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Perform Focused History and Physical
Exam; Take Baseline Vital Signs
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Assessing Cardiac Compromise
Transport immediately if:
No history of cardiac problems
OR
History of cardiac problems, but
no nitroglycerin
OR
Systolic blood pressure is <100
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Assessing Cardiac Compromise
Transport decision:
If available, transport patient to
hospitals that have:
– “Clot-buster” capabilities
– Ability to perform angioplasty
Local protocols will provide
guidance.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Nitroglycerin
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Limmer et al., Emergency Care, 11th Edition
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To Administer Nitroglycerin
Patients must have:
–
–
–
–
Chest pain
History of cardiac problems
Prescribed nitroglycerin with them
BP meets or exceeds local protocol
requirements (often 100 mmHg or greater)
– Not recently taken Viagra or similar drug
for erectile dysfunction
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Medical direction authorizes
administration.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
The Five Rights
Right
patient?
Right
medication?
Right date ?
Five
“Rights”
Right route?
Right dose?
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Nitroglycerin Administration
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Limmer et al., Emergency Care, 11th Edition
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Repeat Nitroglycerin if:
Patient gets no or only partial relief
AND
Blood pressure remains acceptable
per protocol
Medical direction authorizes
another dose
Maximum three doses
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Administration of Aspirin
(if Local Protocols Allow)
Patient must have:
– Chest pain
– No allergies to aspirin
– No history of asthma
– Not taken any other anti-clotting
medications
– Ability to swallow
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Medical direction authorizes
administration.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Cardiac
Compromise
and BLS
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Cardiac Compromise
Click here to view an animation on cardiac compromise.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Cardiac Compromise
Some patients with cardiac
compromise go into cardiac arrest.
You must be prepared for that, but
fortunately, most patients with heart
problems do not go into cardiac
arrest.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
American Heart Association
“Chain of Survival”
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Early Access
Public recognizes an emergency
exists.
Public knows emergency access
phone number (911 or other #).
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Early CPR
Train the public to perform CPR.
Get CPR-trained professionals to the
patient faster.
Train dispatchers to instruct callers
in CPR.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Early Defibrillation
Single most important factor in
survivability (time is critical!)
Automated External Defibrillation
(AED)
Use of nontraditional responders
(police, fire, security, for example)
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Early Advanced Care
Advanced Cardiac Life Support
(ACLS)
Typically provided by
EMT-Paramedics (other EMT
levels may have some options)
Also provided by emergency
department physicians
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Management of Cardiac Arrest
You must be able to:
– Use an automated external defibrillator.
– Request ALS backup when appropriate.
– Use BVM and FROPVD.
– Lift and move patients.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Management Cardiac Arrest
You must also be able to:
– Suction the airway.
– Use airway adjuncts.
– Take Standard Precautions.
– Interview family/bystanders.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Automated External
Defibrillation
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Automated External Defibrillation
Many EMS systems have resuscitated
patients with AEDs (automated
external defibrillators).
The highest survival rates occur in
systems with strong links in the chain
of survival.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Types of AEDs
Semi-automatic/shock advisory
– Computer in AED analyzes rhythm and
advises EMT to deliver shock.
Fully automatic
– EMT turns on power and attaches to
patient; shocks delivered automatically
if needed.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Types of AEDs
Monophasic:
– Sends single shock (energy current)
from one pad to the other
Biphasic:
– Sends shock in both directions,
measures resistance, and adjusts
energy
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– Causes less damage to heart muscle
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Analysis of Cardiac Rhythm
AEDs are extremely accurate in
distinguishing between shockable
and nonshockable rhythms.
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© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Inappropriate Shock
Very rarely does the AED computer
make a mistake.
AED-related errors are almost always
human error due to:
–Touching the patient during analysis.
–Not stopping the ambulance to
analyze rhythm.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Shockable Rhythm
AEDs will shock two rhythms:
Ventricular fibrillation
– Up to 50% of cardiac arrest patients
Ventricular tachycardia over certain
rates
– Up to 10% of cardiac arrest patients
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© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Non-shockable Rhythm
An AED will not shock:
–Asystole (20–50% of victims)
OR
–Pulseless electrical activity (PEA) (15–
20% of victims)
Typically, at most 6 to 7 out of 10
patients are in a shockable rhythm.
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Safety Considerations
An AED must be applied ONLY to a
patient who is unresponsive, apneic,
and pulseless.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Safety Considerations
No one should do CPR or touch the
patient when the AED is analyzing the
rhythm or delivering a shock.
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© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Shock First or Compressions
When the response time is greater than 4 to 5
minutes, it is appropriate to do 2 minutes of
CPR (about 5 cycles) prior to analyzing and
administering the first shock.
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It is appropriate to “re-prime the pump” by
doing CPR for 2 minutes. If you come on the
scene and a citizen or other provider is
already doing high-quality compressions, you
can count that effort toward the first 2 minutes
and proceed with applying the AED.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Witnessed Arrest and
Unwitnessed Arrest
Witnessed arrest
–Do not delay defibrillation to perform
CPR.
–Defibrillation is the top priority!
Unwitnessed arrest
–Do not delay CPR to perform
defibrillation.
–CPR is the top priority!
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© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Take Standard Precautions.
Briefly question bystanders about
pre-arrest events.
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© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Perform Initial Assessment; Verify
Patient Is Pulseless and Not Breathing
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© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
AED Contraindications
Is the patient younger than 1 year
old?
Is there any trauma?
If “yes” to either, do not use the
AED.
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© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Set Up AED as Partner Starts
(or Resumes) CPR
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Turn on Power and, if Appropriate,
Begin Verbal Report
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Firmly Attach One Pad to Right-Upper
Bare Chest; Firmly Place One Pad over
Lower-Left Bare Ribs
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Proper Placement of AED Pads
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Say “Clear!”; Ensure No One Is
Touching Patient; Press Analyze Button
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If AED Advises Shock, Say “Clear”;
Ensure No One Is Touching Patient;
Press Shock Button
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© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Resume CPR for Two Minutes; Check
Effectiveness of CPR by Evaluating
Pulse
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Insert an Airway Adjunct, and Ventilate
with High-Concentration Oxygen
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After Two Minutes of CPR, Clear
Patient and Repeat Sequence
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If No Shock Is Advised, Check Carotid
Pulse; If Present, Assess Adequacy of
Breathing
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If Breathing Is Adequate, Give
High-Concentration Oxygen by
Nonrebreather
If inadequate, ventilate with highconcentration oxygen.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
General AED Procedures
While one EMT operates the AED,
the partner performs CPR.
Defibrillation and CPR are the top
priorities!
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
General AED Procedures
Do not touch patient when analyzing
rhythm and delivering shocks.
Do not analyze rhythm or defibrillate
in a moving ambulance. Stop first.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
General AED Procedures
Be familiar with your model of AED.
Check batteries at beginning of shift.
Follow manufacturer’s charging
recommendations.
Carry an extra battery.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Coordination of EMT and ALS
Call for ALS as soon as possible.
Local protocols determine if you
should wait for ALS or begin
transport to rendezvous with ALS.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
AED in Progress
If AED is in use by a first responder
when you arrive, ensure that the AED
is being used properly, and continue
with shocks.
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Post-resuscitation Care
Maintain airway.
Transfer to ambulance.
Coordinate rendezvous with ALS if
appropriate.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Post-resuscitation Care
Leave AED attached to patient.
– Patient has a high risk of returning to
cardiac arrest.
Perform focused assessment and
ongoing assessment en route.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Post-resuscitation Care
If patient is unconscious, check
pulse at least every 30 seconds.
If no pulse:
– Stop ambulance.
– Analyze rhythm/deliver shocks per
local protocol.
– If AED not available, perform CPR.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Single Rescuer with AED
If the downtime
was prolonged,
perform 2 minutes
of CPR
If the patient was a
witnessed arrest
immediately
defibrillate.
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Pediatrics and AED
Do not use on patients less than 1
year old.
Aggressive airway management and
CPR are best methods.
AED may be beneficial if pediatric
AED is available.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Additional Safety Considerations
Water
– Dry patient’s chest; remove from wet
environment.
Metal
– Ensure no one is touching any metal
that the patient is in contact with.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Additional Safety Considerations
Medication patch
– If patch is visible on chest, remove
it with gloved hands before
delivering shock.
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Limmer et al., Emergency Care, 11th Edition
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Advantages of AEDs
Initial training and continuing
education are simple.
AEDs are very fast.
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Advantages of AEDs
Use of adhesive pads instead of
paddles is safer, provides better
electrode placement, and lowers
EMT’s anxiety.
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Limmer et al., Emergency Care, 11th Edition
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AED Maintenance
AED failure typically results from
inadequate maintenance.
– Failing to check and maintain AED
Use daily checklist to maintain
machine and supplies.
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Limmer et al., Emergency Care, 11th Edition
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AED Quality Improvement
Medical direction
– Review calls.
– Assist in training and skills.
Continuing education
Skill review every three
months
Data collection
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Review Questions
1. What position is best for a patient with:
a. Difficulty breathing and a blood
pressure of 100/70?
b. Chest pain and a blood pressure of
180/90?
2. What is the best way to transfer a
patient with difficulty breathing, chest
pressure, and a blood pressure of
160/100 down a flight of stairs?
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Review Questions
3. Describe how to “clear” a patient
before administering a shock.
4. List three safety measures to keep in
mind when using an AED.
5. List the steps in the application of an
AED.
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Street Scenes
What type of emergency equipment
needs to be taken to the side of every
potential cardiac patient?
What are the treatment priorities for
this patient?
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Street Scenes
What assessment information do you
need to obtain next?
What should you do next?
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Limmer et al., Emergency Care, 11th Edition
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Sample Documentation
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ