USING AN AED

1. USING AN AED Ashland Community And Technical College Presented by Bob Chaffins

2. Introduction • CARDIAC CHAIN OF SURVIVAL • Early recognition and early access • Early CPR • Early defibrillation • Early advanced life support.

3. Introduction • An automated external defibrillator (AED) is a machine that analyzes the heart’s rhythm and, if necessary, tells you to deliver a shock to the victim of sudden cardiac arrest. • The following video segment demonstrates how to use an AED alone and how to use an AED when CPR is already in progress.

4. KEY POINTS • Most cardiac arrests occur away from a hospital. The care needed to immediately correct the cardiac arrest condition is not readily available. • Prompt CPR can help a cardiac arrest victim but is insufficient to correct the underlying heart problem.

5. KEY POINTS • An electric shock is needed to correct the problem in more than two thirds of all cardiac arrests. • The sooner the shock is administered, the greater the likelihood of survival. • This shock is known as defibrillation. • For every minute defibrillation is delayed, chances of survival are reduced 10%.

6. PHYSIOLOGY • Specialized cells of the heart initiate and carry on electrical activity. These cells make up what is commonly called the conduction system. • The conduction system can be thought of as a pathway or road that electrical impulses must travel. • Under normal conditions, this impulse causes the ventricles to contract and forces blood out of the heart to circulate through the body.

7. PHYSIOLOGY • The electrical activity of the heart can be evaluated by a cardiac monitor. • A regular rhythm that occurs within a normal rate, 60-100 beats per minute (bpm), and without unusual variations, is called a normal sinus rhythm.

8. PHYSIOLOGY • Disease or injury can disrupt the conduction system and damage the heart. This disruption can result in an abnormal heart rhythm that can stop circulation. • Ventricular tachycardia (V-tach) and ventricular fibrillation (V-fib) are the most common abnormal rhythms, initially seen in cardiac arrest victims. V-tach often quickly deteriorates to V-fib.

9. PHYSIOLOGY • V-fib is a state of totally disorganized electrical activity in the heart. • It results in the fibrillation, or quivering, of the ventricles. • It is not adequate for the ventricles to pump blood. • V-fib and V-tack can be corrected by defibrillation.

10. PHYSIOLOGY • Rapid defibrillation is the major determinant of survival for these victims. • This is where the importance of the AED access is invaluable.

11. DEFIBRILLATION • During defibrillation, an electrical shock is delivered to the heart. • Defibrillation is not intended to start a dead heart, one without any electrical activity (Asystole). • Defibrillation is intended to disrupt the abnormal electrical activity of V-fib or V-tach long enough to allow the heart to spontaneously develop an effective rhythm

12. DEFIBRILLATION • If not corrected, these rhythms will deteriorate to the point where all electrical activity will cease, a condition known as asystole. • Asystole is not corrected by defibrillation. • It indicates a dead heart, unlikely to be resuscitated.

13. DEFIBRILLATION • AEDs are automatic devices used by first responders. They – • Require less training • Are less expensive. • Are easier to use • They enable first responders to rapidly initiate lifesaving defibrillation to cardiac arrest victims rather than waiting for more advanced personnel to arrive by ambulance.

14. CPR • CPR, begun immediately and continued until defibrillation is available, will help prolong V-fib so that it can be corrected by defibrillation. • CPR also appears to contribute to preserving brain function. • CPR alone cannot maintain V-fib indefinitely nor convert V-fib to a normal sinus rhythm.

15. PRECAUTIONS • AED training devices should never be connected to humans – only manikins. • Live AEDs should never be used for training and never connected to a human for training. • Carefully follow the manufacturer’s instructions for proper de-activation of AEDs used in training.

16. PRECAUTIONS • Treat the AED trainers with respect and do not allow horseplay involving such. • Treat the manikins as if they are actual victims.

17. PRECAUTIONS • Ensure all AED precautions are followed during the class, including, but not limited to the following: • Do not use alcohol to wipe the victim’s chest dry. Alcohol is flammable. • Do not use an AED on a victim in contact with water. • Do not use an AED on a victim lying on a conductive surface.

18. PRECAUTIONS • Do not touch the victim while the AED is analyzing. • Do not defibrillate someone around flammable materials, such as gasoline or free flowing oxygen. • Do not use a cell phone or radio within 6 feet of the AED. This may interrupt analysis. • Remove all jewelry from the victim’s chest.

19. PRECAUTIONS • Do not touch the victim while defibrillating. You or someone else could get shocked. • Do not use an AED in a moving vehicle. Movement may affect the analysis. • Do not use an AED on an infant. • Use the AED on a child under age 8 or under 55 pounds only if you are using pediatric pads or an AED modified for child use only.

20. PRECAUTIONS • Do not us an AED on a victim who has a nitroglycerin or other patch. With a gloved hand, remove any patches from the chest before attaching the device.

21. Frequently Asked Questions • If the location of the pads on the chest is reversed, will the AED still work? • YES. If the placement of the pads is reversed, the AED will still work.

22. Frequently Asked Questions • Should the pads be removed when the AED prompts “no shock advised, continue CPR”? • NO. The pads should not be removed. It is possible that the AED will tell you that additional shocks are needed.

23. Frequently Asked Questions • Are there any special considerations when placing electrode pads on a female victim? • If the victim is wearing a bra, remove it before placing the electrode pads. Place one electrode pad on the victim’s upper right chest (white on right) and one on the lower left side (red on rib), under the victim’s left breast.

24. Frequently Asked Questions • Do AEDs need regular maintenance? • YES. All AEDs need to be maintained on a regular basis. Maintenance includes checking and changing batteries and electrode cables and pads. Always follow the manufacturer’s instructions for maintenance of the AED at your worksite.

25. Frequently Asked Questions • Can AEDs be used safely in the rain and snow? • YES. It is safe to use AEDs in all weather conditions. However, if at all possible, move to shelter to keep the victim protected from inclement weather. If the victim is lying in water, move him or her to a relatively dry area before using the AED. In wet weather, dry the victims chest before placing the electrode pads.

26. Frequently Asked Questions • Can an AED be used on a young child or an infant? • NO. Use of an AED is not recommended for an infant or child younger than 8 years old or under 55 pounds. For an infant or child younger than 8 years old or under 55 pounds, initial priority of care is CPR. • Child defibrillators are now becoming available.

27. Frequently Asked Questions • Can I defibrillate a pregnant woman? • YES. Defibrillation shocks transfer no significant electrical current to the fetus. Local protocols/medical direction should be followed.

28. SKILL (5 basic steps) • Confirm cardiac arrest (unresponsive, not breathing, pulseless). • Turn on the device. • Attach the device to the victim. • Dry the chest first with gauze. • Analyze the rhythm. • Deliver a shock, if indicated.

29. SKILL • Apply the emergency action steps: CHECK, CALL, CARE. • Apply basic precautions to reduce the risk of disease transmission. (BSI) Use disposable gloves and a breathing barrier.

30. SKILL (basics) • When an AED becomes available – • Turn on the AED • Apply the pads. Dry the chest first with gauze. • Let the AED analyze the victim’s heart rhythm (or push “analyze” if needed) • Deliver a shock when prompted • Make sure no one is touching the victim when the AED is analyzing. • Make sure no one is touching the victim before a shock is given.

31. USING THE AED • Once turned on, AEDs are capable of recording the events in the care of the victim. • Attach the device to the victim by applying two adhesive pads to the victim’s chest. • White on right • Red on ribs.

32. USING THE AED • Ensure that the chest is bare and dry. • Remove the pads from their packaging. • Connect the two cables from the AED to the pads if necessary. • Peel away the protective plastic backing from the pads • Place the pads, adhesive-side down, on the victims chest, according to manufacturer’s directions.

33. USING THE AED • If the pads are not securely attached to the chest, or if the cables are not fastened properly, you will receive an “error” or “no contact” message. • Analyze the heart rhythm. • Stand clear of the victim. (Verbalize) • Press the button marked “analyze” if needed to have the AED examine the heart rhythm.

34. USING THE AED • Allow the machine to analyze the rhythm for several seconds. • The AED will notify you by an on-screen message or voice prompt if it detects a rhythm that should be defibrillated. • Stand clear of the victim. (Verbalize) • The AED will charge to the appropriate energy level and deliver a shock automatically. Some devices require the operator to do so by pressing a button. • The heart will not always need defibrillation. The device will inform you if no shock is needed.

35. USING THE AED • Deliver one shock. • Re-analyze the rhythm. • Continue two minutes of CPR and repeat this cycle. • The heart will not always indicate a shock. • Recheck the victim’s pulse. If it is still absent, perform two minutes of CPR.

36. Summary • Prompt CPR can help a cardiac arrest victim, but is insufficient to correct the underlying heart problem. • An electric shock is needed to correct the problem in more than two thirds of all cardiac arrests. This shock is known as defibrillation. • Defibrillation is not intended to start a heart, on without electrical activity.

37. Summary • AEDs are effective at helping to save the lives of victims of cardiac arrest. • You should follow the 5 basic steps for use of an AED. • Confirm cardiac arrest. • Turn on the device. • Attach the device to the victim. • Analyze the rhythm. • Deliver a shock, if indicated.

38. Scenario • You are at work taking a break when you find a co-worker who appears to be unconscious. No one else standing around knows CPR or how to use an AED, but an AED is nearby.

39. Scenario cont. • Participant action • Check • Victim is unconscious • Participant action • Instructs someone to call emergency number and retrieve AED. • Participant action • Victim is not breathing

40. Scenario cont. • Provides two breaths • Participant action • Check for circulation • No pulse • Participant action • Gives CPR • 3 cycles and AED arrives

41. Scenario cont. • Gives 1 shock • Participant action • Reanalyze rhythm • Participant action • Gives CPR for 2 minutes if indicated • Participant action • Analyze and shock 1 time

42. Scenario cont. • Participant action • Checks pulse and breathing • Pulse and breathing restored.

43. Examination • Early defibrillation is an important link in the cardiac chain of survival because – • Each minute that defibrillation is delayed reduces the victim’s chance of survival. • Defibrillation can help prevent stroke • A cardiac arrest victim may have an un-shockable rhythm • All of the above

44. Examination • Where should you attach the AED pads to the victim? • One on the center of the chest and one on the lower abdomen • One on the lower left side and one on the lower right side • One on the upper right chest and one on the lower left side. • Both pads on the upper chest

45. Examination • Which of the following precautions apply when using an AED? • Do not touch the victim while the AED is analyzing • Do not touch the victim when defibrillating • Do not use an AED on a victim lying on a conductive surface • All of the above.

46. Examination • Before delivering a shock with an AED you should – • Do a finger sweep • Place the victim on his or her side • Have another responder hold the victim • Instruct others to stand clear.

47. Examination • You are giving care to a victim with no pulse. After you give 2 shocks the AED prompts, “No shock advised”. What action should you take next. • Check for a pulse. • Push the shock button anyway • Start CPR • Give 2 slow breaths

48. Examination • If CPR is not started, how long after cardiac arrest will the brain begin to die? • Immediately • 2-4 minutes • 4-6 minutes. • 8-10 minutes

49. Examination • Which is the primary sign of cardiac arrest? • No breathing • Absence of a pulse. • Absence of blood pressure • Dilation of the pupils

50. Examination • What should you do if a victim’s breathing and pulse return while caring for cardiac arrest. • Have a bystander transport you and the victim to the hospital • Continue rescue breathing while waiting for advanced medical personnel to arrive. • Complete a secondary survey before calling advanced medical personnel • Keep the airway open and monitor vital signs until advanced medical personnel arrive.