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EMT Defibrillation

EMT Defibrillation. A LWTC/NSCC presentation. Objectives. Understand cardiac arrest physiology and impact CPR/AED has on patient outcomes Demonstrate knowledge and understanding of AED use in role as the EMT/Defib Tech in cardiac arrest. Some Statistics.

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EMT Defibrillation

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  1. EMT Defibrillation A LWTC/NSCC presentation

  2. Objectives Understand cardiac arrest physiology and impact CPR/AED has on patient outcomes Demonstrate knowledge and understanding of AED use in role as the EMT/Defib Tech in cardiac arrest

  3. Some Statistics Seattle-King County EMS agencies responded to 1035 cardiac arrest patients in 2007 302 (29%) of these patients initially presented in VF/VT Survival rate (post VF arrest) for Seattle-King County is 45%

  4. Goals Quality CPR is to be performed and interrupted for a minimal amount of time VF/VT to be shocked as soon as defibrillator is available Overall patient care and safety are never to be neglected

  5. Your Goal…

  6. Basic Cardiac Physiology

  7. Normal Cardiac Conduction Electrical pattern ECG tracing

  8. Cardiac Arrest • Occulsion of the coronary artery leads to ischemia • Ischemia leads to infarct which causes interruption of normal cardiac conduction • Infarct = VF/VT

  9. Shockable Rhythms Ventricular Fibrillation Ventricular Tachycardia

  10. Defib Procedure

  11. Equipment • AED is capable of analyzing shockable rhythms • Delivers biphasic shock (120-200 joules) • Can be used for pediatric pts (< 8) with adult/pediatric pads

  12. Defibrillation Basics Shockable rhythm is defined as VF or unconscious/pulseless VT. CPR must be performed with minimal interruptions except in cases of airway management (aspiration of emesis)

  13. Defibrillation Basics • Before the AED can be turned on the patient must be: • Unconscious • Unresponsive • Apneic • Pulseless

  14. Defib Procedure Check for consciousness/responsiveness. Access ABCs. If not breathing, open airway & begin ventilations. Check pulse. If pulse not present, initiate CPR. Turn on defibrillator, apply pads, begin verbal report. Allow defibrillator to analyze (stop CPR)

  15. Pad Placement

  16. AED will analyze… …shockable rhythm of VF/pulseless VT and deliver command to deliver shock OR …non-shockable rhythm and deliver command to resume CPR

  17. Shock Advised (VF or VT) Clear patient from head to toe (SAFETY!) Deliver single shock Immediately begin CPR and continue for 2 minutes. Do not delay CPR for pulse check or post-shock rhythm analysis.

  18. Shock Advised (VF or VT) After 2 minutes of CPR, analyze rhythm (stop CPR) No pulse check required If shock is indicated, clear patient, and deliver 2nd shock. Continue uninterrupted CPR for 2 minutes

  19. Shock Advised (VF or VT) After 2 minutes of CPR, analyze rhythm (stop CPR) No pulse check required If shock is indicated, clear patient, and deliver 3rd shock. Continue uninterrupted CPR for 2 minutes.

  20. Shock Advised (VF or VT) After 2 minutes of CPR, analyze rhythm (stop CPR) No pulse check required If shock is indicated, clear patient, and deliver shock. Continue uninterrupted CPR for 2 minutes. Continue process until Medic arrival

  21. No Shock Advised Immediately begin CPR Continue uninterrupted CPR for 2 minutes Do not delay CPR for pulse check

  22. No Shock Advised After 2 minutes of CPR, analyze rhythm (stop CPR) Do not check pulse before analyzing rhythm If No Shock is advised, check pulse. No pulse, continue uninterrupted CPR for 2 minutes

  23. No Shock Advised If pulse is present after pulse check, obtain patient’s blood pressure, check airway to ensure it is clear, and assess breathing for adequate breathing. Assist ventilations if inadequate. If blood pressure < 60 mmHg systolic, perform uninterrupted CPR for 2 minutes

  24. No Shock Advised After 2 minutes of CPR, analyze patient (stop CPR) Do not check pulse before analyzing rhythm If No Shock advised, check pulse. If no pulse, continue uninterrupted CPR for 2 minutes After 3rd No Shock, continue CPR without analyzing patient

  25. Safety

  26. Safety Defib tech is in charge at ALL times! You are responsible for the overall quality of airway management, CPR, and safe, effective defibrillation Be sure to clear patient from head-to-toe prior to delivering shock

  27. Special Circumstances Pediatric patients (< 1 year old) Trauma patients Hypothermia

  28. Questions?

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