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Automatic External Defibrillator

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- Why we use the AED?- How to use the AED?- Indications for the AED?

- Contraindications to AED?

Objectives for this subject

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The chain of survival:- early access to 911

-early CPR-early defibrillation-early advanced care

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Defibrillation is the application of electrical shock to

help restore the heart’s regular

rhythm

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Defibrillator is the device used to deliver that shock and it can be

manual or automatic.

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Early defibrillation is the single most important factor in

determining survival from cardiac arrest.

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• Defibrillation should be performed with in the first 8 minutes after cardiac arrest. Ideally, the sooner, the better.

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AED

• Most common initial rhythms patients go into as they enter into cardiac arrest are:

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“2 Shockable Rhythms”

V-Tach and V-Fib

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Ventricular Tachycardia:Fast heart rhythm which does not allow

the heart to fill properly and cardiac output is compromised and reduced.

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Ventricular Fibrillation:disorganized series of electrical

discharges in the ventricles. Where the ventricles “quiver”.Stops Cardiac output

and hearts pumping ability.

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AED’s that are available are automatic and semi-automatic.

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Automatic: where machine does all of the work.

Semi Automatic: where machine tells you when to push button to

deliver shock.

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Apply AED as soon as you

determine that your patient is not breathing and does not have a pulse.

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Always making sure that CPR is still in progress while you are

setting up the AED.

If by yourself, apply the AED.

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• Ensure before putting pads on chest, it is clear of all patches, paste or pacemakers. Don’t cover something up with pad.

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• If patient has hair on chest that could interfere with conduction, make sure you shave it off with razor provided to you.You want pads on chest to fit snug and secure.

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Now attach the adhesive pads to the cables remembering-

White is negativeWhite is negative, anterior chest wall.Red is positiveRed is positive ,

left anterior axillary line.

“Red on Ribs! WhiteWhite on right!”

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Do Not Utilize The Anterior – Posterior (Front and Back) Lead

Placement For Automatic Defibrillation

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Now turn on machine and

wait for AED to analyze the

patients rhythm. Making sure that CPR has

been stopped for machine to

detect rhythm.

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While waiting for machine, you can begin your patient

information by speaking clearly into the tape recorder of the machine. You want to give

certain information.

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- Patients age.- Patients past medical history.- Patients medications. - Brief description of what happened prior to your arrival.

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When machine advises a shock is indicated, ”CLEARCLEAR”

your patient.

Ensuring that no one is touching patient or stretcher.

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When the AED delivers a shock it will go back and reanalyze the

rhythm.

If another shock is appropriate“Clear Patient”“Clear Patient”

anddeliver the shock.

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Sets of 3 shocks are called stacked shocks and they are done

without any pauses to check patients pulse or administer CPR

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If “No shock” is indicated:

-Check breathing give appropriate oxygen therapy.

-Check pulse, if no pulse! Start CPR for

1 minute and then have the AEDreassess.

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Transport patient when:

*Patient regains a pulse

*Total of 6 shocks have been given.

*AED has indicated 3 “no shocks”with intervening CPR.

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Defibrillator

Some ALS providers will choose to leave the AED in place.

Some will choose to use their monitor for manual defibrillation.

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Safety should always be maintained by the provider:

-Not using near or around water

-Ensuring all med patches and pastes are off the patient.

-Making sure that everyone is clear of the patient when the shock is delivered.

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Indications for AEDIndications for AED * Unresponsive * Apneic * Pulseless patients.

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Adult Patients• > 8 years old

• > 55 lbs.

• Unresponsive,pulseless and apneic.

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Contraindications:

• Infants and children

• < 8 years old

• < 55 lbs.

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Contraindications:

!! HypothermiaHypothermia !!

(Contact medical control)

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Contraindications:

Rigor / Livor Mortis

No Code /DNR

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The AED can’t properly analyze patient in moving

ambulance.

It is recommended that you stop the medic and let AED do it’s

job.

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Please review your RegionalMedical Protocol Manual

for further information