Download AED

Automated External
Defibrillators (AEDs)
Appendix A
Topic Overview
– Rationale for early defibrillation.
– When defibrillation to appropriate.
– How defibrillation works.
– General steps for the use of an automated
external defibrillator (AED).
AEDs
• The heart's electrical system
– Conduction system
• Originates in the atria
– sinoatrial node (SA)
– atrioventricular node (AV)
• Ends in the ventricles
AEDs
– Cardiac Rhythms
•
•
•
•
•
Normal sinus rhythm
Ventricular fibrillation (V-fib)
Ventricular tachycardia (V-tach)
Asystole
Pulseless electrical activity (PEA)
AEDs
• Defibrillation
– Protocol for using an Automated External
Defibrillator (AED)
– When the Heart Fails
• Early defibrillation provides the best chance for
survival
• Rhythms which will respond to defibrillation
– Ventricular tachycardia (V-tach)
– Ventricular fibrillation (V-fib)
– Coarse & Fine
• Other abnormal heart rhythms will Not respond
to defibrillation
AEDs
• The Role of CPR
– Begun immediately circulates oxygenated
blood
• Appears to contribute to preserving brain
function
– Alone CAN NOT maintain or convert V-fib
to a normal sinus rhythm
• CPR & defibrillation when done together
significantly enhance chances of survival
• Delaying CPR or defibrillation reduces
chances of survival.
AEDs
• Time Line - % Survival
– No treatment - 0%
– Delayed Defibrillation - 2%
– Early CPR, Delayed Defibrillation - 8%
– Early Access, Early CPR, Early
Defibrillation - 20%
– Early Access, Early CPR, Early
Defibrillation, Early ACLS - 30-40%
AEDs
• Defibrillation
– IS NOT intended to restart a heart
– IS intended to briefly disrupt abnormal
electrical activity (V-tach/V-fib)
– If not corrected abnormal heart rhythms will
lead to asystole
– Asystole is NOT correctable by
defibrillation
• Requires CPR
Analysis of Cardiac
Rhythm
AEDs are extremely accurate
in distinguishing between
shockable
and non-shockable rhythms.
Inappropriate Shocks
 Very rarely does AED computer
make a mistake.
 AED-related errors are almost
always human.
• Not clearing patient
• Not stopping ambulance to analyze
rhythm
AEDs
• Advantages
– Requires less training than traditional
manual defibrillators
– Are less expensive than manual units
– Are easier to use than manual units
– Can enable 1st responders to rapidly
initiate defibrillation
AEDs
– Can automatically recognize a shockable
heart rhythm
• Can deliver up to three stacked shocks
• Delivers subsequent shocks at max joules
• All units set to deliver up to 9 shocks
– Parker Units are programmed to deliver up to 12
shocks
AEDs
• Use and operation (2 Rescuers)
– All AEDs can be operated by flowing these
basic steps:
• Confirm cardiac arrest
(unresponsive, not breathing, no pulse)
• Set up AED as partner starts CPR
• Turn on power
• Place one pad to upper right chest, second pad
over lower left ribs
• Stop CPR, Stay clear of patient
AEDs
• Use and operation (2 Rescuers)
• If shock advised, say “I’m clear, your clear,
we’re all clear”, then press shock button.
• Resume CPR for two minutes
• After two minutes of CPR, clear patient and
repeat sequence of analysis followed by one
shock if indicated.
AEDs
• Use and operation (1 Rescuer)
– Witnessed Arrest
• Establish responsiveness, contact 911, check
pulse, turn on AED and apply pads.
• Deliver 1 shock if indicated
• Perform 2 minutes of CPR (5 cycles)
• Repeat shock and CPR as indicated
– Unwitnessed Arrest
AEDs
• Use and operation (1 Rescuer)
– UnWitnessed Arrest
• Establish responsiveness, contact 911, check
pulse
• Perform 2 minutes of CPR (5 cycles)
• Turn on AED and apply pads.
• Deliver 1 shock if indicated
• Perform 2 minutes of CPR (5 cycles)
• Repeat shock and CPR as indicated
AEDs
• Precautions
– Do not clean chest with alcohol pads
– STAND CLEAR of victim while unit is
analyzing the rhythm and defibrillating
– Do not attempt to use in a moving vehicle
– Do not defibrillate a victim who is in water
• When using around pool, place victim in a dry
area by sure feet are dry
• Keep all bystanders sway from puddles of
water
AEDs
• Precautions
– Do not defibrillate a victim in contact
with metal
– Do not defibrillate a victim who is less
than 1 YOA (AHA).
– Avoid radio transmissions or cell phone
usage within 6 feet when using an AED
AEDs
• Precautions
– Keep delivery devices with flowing oxygen
away from the victim
– If you suspect a pacemaker, do not place
the AED pads directly over the top
– Be sure to remove any nitroglycerin
patches
• Wipe off adhesive with alcohol prep pad and
then dry completely to remove alcohol
AEDs
• Precautions
– If victim is suffering from hypothermia,
deliver no more than three shocks,
continue CPR even if the AED prompts you
to shock again.
• Victim may be severely bradycardic
– AED will not recognize
Early Defibrillation Program
• Establishing a Program
– Must consider:
• Size, age & location of the populations to be
served
• The number of trained responders
• The response times of first responders and
more advanced personnel
• The number of AEDs available
• Where the AEDs should be placed within the
community or facility
Early Defibrillation Program
• Establishing a Program
– Must consider:
• Commitment to the program from the local
medical director and EMS
• State requirements for purchase,
ownership, use and certification