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Automated External Defibrillation

Automated External Defibrillation. “Chain of Survival”. Early access Early CPR Early defibrillation Early advanced life support. Defibrillation is “Part of BLS”. Basic Life Support includes CPR and defibrillation

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Automated External Defibrillation

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  1. Automated External Defibrillation

  2. “Chain of Survival” • Early access • Early CPR • Early defibrillation • Early advanced life support

  3. Defibrillation is “Part of BLS” • Basic Life Support includes CPR and defibrillation • Early defibrillation with an automated external defibrillator (AED) has established benefit • The principle of early defibrillation suggests that the first person to arrive at the scene of a cardiac arrest should have a defibrillator • This principle is now internationally accepted Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care p. I-68

  4. Early Defibrillation Effectiveness • Rural and urban U.S. studies • Substantial increases in survival 30 Before 25 After 20 % Survival 15 10 5 0 King CountyWashington Iowa SoutheastMinnesota NortheastMinnesota Wisconsin Textbook of Advanced Cardiac Life Support, Chapter 20, 1990, p. 289

  5. Early Defibrillation by Police and Paramedics—Rochester, MN Survival to Number hospital discharge First shocked 31 18 (58%)by police First shocked 53 23 (43%)by paramedics Overall survival to hospital discharge = 49% White RD, et al. Annals of Emerg Med. 1996;28:480–485.

  6. Electrical Conduction System of the Heart Atrioventricular Node Left Atrium Bundle of His Internodal Pathways Left Bundle Branch Sinoatrial Node Right Atrium Left Ventricle Right Bundle Branch Purkinje Fibers Right Ventricle

  7. Normal Conduction Pathway in the Heart and the ECG Sinoatrial (SA) Node Atrioventricular (AV) Node Left Bundle Branches Right Bundle Branch Purkinje Fibers P T P = Atrial Depolarization QRS = Ventricular Depolarization T = Ventricular Repolarization QRS

  8. Normal Sinus Rhythm Sinoatrial Node 12:56 29MAR96 PADDLES X1.0 HR = 74

  9. Ventricular Fibrillation 12:57 29MAR96 PADDLES X1.0 HR = ---

  10. 300 JOULES DEFIB 20:29 01APR96 PADDLES X1.0 HR = --- Defibrillation: The Only Effective Treatment for Ventricular Fibrillation

  11. “Thanks, I needed that!”

  12. Why Early Defibrillation? • VF most frequent initial rhythm in sudden cardiac arrest • Defibrillation most effective treatment • Probability of defibrillation success diminishes with time • VF tends to rapidly deteriorate into asystole Textbook of Advanced Cardiac Life Support, Chapter 20, 1990; p. 287.

  13. 100 90 80 70 60 50 40 30 20 10 0 1 2 3 4 5 6 7 8 9 Resuscitation Success vs. Time* Success rates decrease 7-10% each minute % Success Adapted from text: Cummins RO, Annals Emerg Med. 1989, 18:1269-1275. * Non-linear Time (minutes)

  14. Ventricular Tachycardia 12:57 29MAR96 PADDLES X1.0 HR = 214

  15. Asystole 15:17 29MAR96 PADDLES X1.0 HR = ---

  16. Automated External Defibrillators • Analyze patient ECG • only for unconscious, pulseless victims with no spontaneous breathing and no signs of circulation • Determine via computer algorithm shockable or non-shockable rhythm • Advise operator “SHOCK” or “NO SHOCK” • Shock ventricular fibrillation and certain ventricular tachycardias

  17. LIFEPAK®500 Automated External Defibrillators

  18. Anterior-lateral placement Defibrillation Electrode Placement Anterior Lateral

  19. Next time, remove his shirt!

  20. Defibrillation Electrode Placement • Correct electrode position optimizes the amount of current flowing through the ventricles Correct electrode position Incorrect electrode position

  21. How to Defibrillate • Verify the victim is unconscious, not breathing, without a pulse or signs of circulation • Turn on AED and attach electrodes • ANALYZE heart rhythm • Follow the voice prompts and screen messages

  22. Safety First • Attach the defibrillator only to someone not breathing and without a pulse or signs of circulation • Make sure no one is touching the victim • Be sure the electrodes are firmly adhered to the victim’s chest • Move oxygen away from the rescue effort before defibrillation

  23. You should have said “clear”!

  24. Police Golf Pros Lifeguards Health Club Employees Who is Using AEDs Today? • Flight Attendants • Firefighters • EMTs • Corporate Emergency Response Teams • Security Officers

  25. Advantages of AEDs • Eliminates need to recognize rhythms • Personnel with less training can defibrillate • May reduce time to therapy—access to more treatable rhythms • Makes early defibrillation practical and achievable

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