Automatic Implantable Cardiac Defibrillators (2 of 2)

1
Automatic Implantable Cardiac Defibrillators (2
of 2)

• Monitor heart rhythm and deliver shocks as
  needed.
• Low electricity will not affect rescuers.

2
Cardiac Arrest

• The complete cessation of cardiac activity,
  either electrical, mechanical, or both.

3
Automated External Defibrillator (AED)

• AEDs come in various models.
• Some operator interaction required.
• A specialized computer recognizes heart rhythms
  that require defibrillation.

4
Potential AED Problems

• Battery is dead.
• Patient is moving.
• Patient is responsive and has a rapid pulse.

5
AED Advantages

• ALS providers do not need to be on scene.
• Remote, adhesive defibrillator pads are used.
• Efficient transmission of electricity

6
Non-Shockable Rhythms

• Asystole
• Pulseless electrical activity

7
Rationale for Early Defibrillation

• Early defibrillation is the third link in the
  chain of survival.
• A patient in ventricular fibrillation needs to be
  defibrillated within 2 minutes.

8
AED Maintenance

• Read operators manual.
• Check AED and battery at beginning of each shift.
• Get a checklist from the manufacturer.
• Report any failures to the manufacturer and the
  FDA.

9
Medical Direction

• Should approve protocols
• Should review AED usage
• Should review speed of defibrillation
• Should provide review of skills every 3 to 6
  months

10
Preparation

• Make sure the electricity injures no one.
• Do not defibrillate a patient lying in pooled
  water.
• Dry a soaking wet patients chest first.
• Do not defibrillate a patient who is touching
  metal.
• Remove nitroglycerin patches.
• Shave a hairy patients chest if needed.

11
Using an AED (1 of 8)

• Assess responsiveness.
• Stop CPR if in progress.
• Check breathing and pulse.
• If patient is unresponsive and not breathing
  adequately, give two slow ventilations.

12
Using an AED (2 of 8)

• If there is a delay in obtaining an AED, have
  your partner start or resume CPR.
• If an AED is close at hand, prepare the AED pads.
• Turn on the machine.

13
Using an AED (3 of 8)

• Remove clothing from the patients chest area.
  Apply pads to the chest.
• Stop CPR.
• State aloud, Clear the patient.

14
Using an AED (4 of 8)

• Push the analyze button, if there is one.
• Wait for the computer.
• If shock is not needed, start CPR.
• If shock is advised, make sure that no one is
  touching the patient.
• Push the shock button.

15
Using an AED (5 of 8)

• After the shock is delivered, most AEDs will
  automatically reanalyze the rhythm if not, push
  the analyze button again.
• If the machine advises a shock, deliver a second
  shock.
• Reanalyze the rhythm.
• If the machine advises a shock, deliver a third
  shock.

16
Using an AED (6 of 8)

• Check for pulse.
• If the patient has a pulse, check breathing.
• If the patient is breathing adequately, provide
  oxygen via nonrebreathing mask and transport.

17
Using an AED (7 of 8)

• If the patient is not breathing adequately, use
  necessary airway adjuncts and proper positioning
  to open airway.
• Provide artificial ventilations with
  high-concentration oxygen.
• Transport.

18
Using an AED (8 of 8)

• If the patient has no pulse, perform 1 minute of
  CPR.
• Gather additional information on the arrest
  event.
• After 1 minute of CPR, make sure no one is
  touching the patient.
• Push the analyze button again (as applicable).
• If necessary, repeat one cycle of up to three
  stacked shocks.
• Transport and check with medical control.
• Continue to support the patient as needed.

19
After AED Shocks

• Check pulse.
• No pulse, no shock advised
• No pulse, shock advised
• If a patient is breathing independently
• Administer oxygen.
• Check pulse.
• If a patient has a pulse but breathing is
  inadequate, assist ventilations.

20
Transport Considerations

• Transport
• When patient regains pulse
• After delivering six to nine shocks
• After receiving three consecutive no shock
  advised messages
• Keep AED attached.
• Check pulse frequently.
• Stop ambulance to use an AED.

21
Cardiac Arrest During Transport (1 of 2)

• Check unconscious patients pulse every 30
  seconds.
• If pulse is not present
• Stop the vehicle.
• Perform CPR until AED is available.
• Analyze rhythm.
• Deliver shock(s).
• Continue resuscitation according to local
  protocol.

22
Cardiac Arrest During Transport (2 of 2)

• If patient becomes unconscious during transport
• Check pulse.
• Stop the vehicle.
• Perform CPR until AED is available.
• Analyze rhythm.
• Deliver up to three shocks.
• Continue resuscitation according to local
  protocol.