Automatic Implantable Cardiac Defibrillators (2 of 2)

1. Monitor heart rhythm and deliver shocks as needed. Low electricity will not affect rescuers. Automatic Implantable Cardiac Defibrillators (2 of 2)

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 operator’s 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 patient’s chest first. • Do not defibrillate a patient who is touching metal. • Remove nitroglycerin patches. • Shave a hairy patient’s 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 patient’s 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 patient’s 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.