Automatic External Defibrillation Aaron J. Katz, AEMT-P, CIC Revised for 2005 AHA Protocols.
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Transcript of Automatic External Defibrillation Aaron J. Katz, AEMT-P, CIC Revised for 2005 AHA Protocols.
![Page 1: Automatic External Defibrillation Aaron J. Katz, AEMT-P, CIC Revised for 2005 AHA Protocols.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649dfe5503460f94ae6b8b/html5/thumbnails/1.jpg)
Automatic External Defibrillation
Aaron J. Katz, AEMT-P, CICwww.es26medic.net
Revised for 2005 AHA Protocols
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AHA Chain of Survival
Early access Early CPR Early defibrillation Early ALS
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Cardiac electrophysiology SA Node
“dominant pacemaker” “Fires” 60-100 times per minute
Internodal pathways AV Node Bundle of HIS Left and right bundle branches Purkinje network
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Nonperfusing heart rhythms
Ventricular tachycardia (“VTACH”)
Ventricular fibrillation (“VFIB”) Asystole Electromechanical dissociation
(EMD) Pulseless electrical activity (PEA)
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VTACH
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VFIB
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Asystole
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The bottom line
All the above abnormal heart rhythms can not produce a perfusing pulse
Pulseless VTACH and VFIB CAN be successfully converted to a perfusing rhythm using a defibrillator
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AED – the technology
Very accurate computer enabling recognition of lethal rhythms (“Analyze”)
Modern AED will talk Shocking mechanism (“Shock”) Automatic vs. semiautomatic
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Common AED errors
Bad battery Patient moving AED applied to a responsive
patient
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Bad battery
Use fully charged batteries Depends on manufacturer
Pay attention to AED warnings about batteries
Bad batteries are uncommon today COLD WEATHER
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Patient moving
Causes inaccurate analysis Don’t touch the patient Stop the bus when analyzing!
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AED applied to a responsive patient
AED applied to a responsive patient with a rapid pulse
AED may falsely interpret as VTACH – and recommend shock
Therefore: only apply AED to an unresponsive pulseless patient
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Complications & solutions Patient has a pacemaker
Apply pads 1” from pacemaker AICD
No danger to EMT! Small amount of energy Apply pads 1” from pacemaker
Very hairy chest Shave the area Keep a disposable razor with your
defibrillator
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Integrating AED into CPR
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AED integration Arrive at the scene Assess responsiveness Stop CPR (EMTs or bystanders) Verify pulselessness & apnea EMS Witnessed Arrest?
Perform CPR until defibrillator is attached
Arrest not witnessed by EMS? Two minutes of CPR prior to using
defibrillator
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AED integration – cont’d Prepare for defibrillation:
Bare the chest Remove nitro paste/patches Apply pads to the chest Look at the pads, they show you how
Right: right of sternum under clavicle Left: left ribs
Top of pad should 2-3” below armpit Apply them smoothly
STOP CPR
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AED integration – cont’d
Shout “clear” 3 times “I’m clear, you’re clear, everybody
clear” Analyze
AED may tell you “analyzing – do not touch the patient”
Results…
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AED integration – cont’d Analysis at any time will result in
either: Shock advised
AED will charge and tell you to clear the patient and press shock
No shock advised Patient may have a pulse Patient has a nonshockable rhythm
Asystole, EMD/PEA
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Shocks recommended
One Shock Check pulse… Two minutes of CPR Press Analyze Shock if recommended Two minutes of CPR …
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Continue
After 3 cycles of CPR or if spontaneous breathing occurs, begin transport
During transport, continue CPR, re-analyze every 2 minutes, and shock as indicated
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No shock advised No spontaneous breathing?
2 minutes of CPR Analyze/Shock as indicated/2 minutes of
CPR cycles Spontaneous breathing
Assess vital signs Support airway Support breathing
Transport