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Loudoun County AED Program

Loudoun County AED Program. AED. Teamwork* Integrity* Professionalism* Service*. Objectives. Identify the function and anatomy of the heart Properly operate the AED Integrate AED into CPR/scene management Identify any special circumstances that impact AED use

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Loudoun County AED Program

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  1. Loudoun County AED Program AED Teamwork* Integrity* Professionalism* Service*

  2. Objectives • Identify the function and anatomy of the heart • Properly operate the AED • Integrate AED into CPR/scene management • Identify any special circumstances that impact AED use • Maintaining and identifying problems associated with the AED Teamwork* Integrity* Professionalism* Service*

  3. Definition “Defibrillation is the delivery of an electric current through the chest wall and heart for the purpose of terminating ventricular fibrillation or pulseless ventricular tachycardia and restoring a perfusing rhythm.” Teamwork* Integrity* Professionalism* Service*

  4. A & P of the Heart A network of specialized tissue, capable of conducting electrical current, runs throughout the heart muscle. As electrical impulses travel through this network, coordinated contractions of the heart muscle occur. Teamwork* Integrity* Professionalism* Service*

  5. Electrical Pathway • Sinoatrial Node (SA) • Atrioventricular Node (AV) • Bundle of His • Bundle Branches • Purkinje Fibers Teamwork* Integrity* Professionalism* Service*

  6. Heart Function • Electrical • Electrical impulses through the heart. • Evaluated with ECG monitor. • An electrical rhythm does not mean there is a pulse! • Mechanical • Actual pumping of the heart. • Evaluated by checking pulse. Teamwork* Integrity* Professionalism* Service*

  7. Shockable Rhythms • Pulseless Ventricular Tachycardia (VT) may be the initial rhythm for a patient in cardiac arrest. • Ventricular Fibrillation (VFib) is the most frequent rhythm present when a patient is found in cardiac arrest. • Ventricular Fibrillation is a useless quivering of the heart that results in no blood flow, therefore no pulse. • Early Defibrillation is the only effective treatment for Ventricular Fibrillation. • AEDs shock Pulseless Ventricular Tachycardia (VT) and Ventricular Fibrillation (VFib). Teamwork* Integrity* Professionalism* Service*

  8. Shockable Rhythms Ventricular Fibrillation Pulseless Ventricular Tachycardia Teamwork* Integrity* Professionalism* Service*

  9. The absence of any electrical impulse is called Asystole Teamwork* Integrity* Professionalism* Service*

  10. AEDs and Ventricular Fibrillation/Pulseless Ventricular Tachycardia • Defibrillation “shocks” the heart in an effort to restore normal electrical activity of the heart. • Defibrillation is the only effective treatment for VF/Pulseless VT, once the patient’s pump has been “primed” • The ability to successfully defibrillate a patient into a normal rhythm diminishes rapidly over time. Teamwork* Integrity* Professionalism* Service*

  11. AEDs used by Loudoun County Fire & Rescue Companies Lifepak 1000 Lifepak 12 Lifepak 15 All units are biphasic Teamwork* Integrity* Professionalism* Service*

  12. AEDComponents/Accessories • Battery • Microprocessor/Charging Unit • Pads & Cables • Extra pads • Razor • Wash cloth • Spare batteries & Paper (for LP 12/15) Teamwork* Integrity* Professionalism* Service*

  13. Laerdal Heart Stream Found in Purcellville Police vehicles . Purcellville Town Administration Middleburg Town and Police Pads are not compatible with Medtronic (Lifepak) units Teamwork* Integrity* Professionalism* Service*

  14. Authorized Use of AED • Granted to locally authorized EMR, EMT, EMT-I, AEMT, Paramedic • Active member of OEMS EMS Licensed Agency authorized to operate in Loudoun County • Current BLS – AHA Healthcare Provider • Recertification every 12 months Teamwork* Integrity* Professionalism* Service*

  15. Indications for Use • Standing Order –Cardiac Arrest Pulseless and Apneic Regardless of age (from birth) Teamwork* Integrity* Professionalism* Service*

  16. Definitive Signs of Death (DOA) • Criteria • Decomposition • Lividity or dependent pooling of blood • Obvious mortal injury that is inconsistent with life • Rigor mortis • Presence of a valid Virginia Durable Do Not Resuscitate (DDNR) order • If in doubt, begin resuscitation and contact medical control for guidance Teamwork* Integrity* Professionalism* Service* 16

  17. Scene Safety/BSI • Make sure that the environment is safe. • Is the patient lying in water? • Do you need to move the patient before starting care? • It is not safe to defibrillate in a moving ambulance! Teamwork* Integrity* Professionalism* Service*

  18. Initial Assessment • Level of Consciousness • Check for signs of life (breathing, chest rise) • Circulation • Check pulse • Begin CPR with 30 chest compressions • Airway • After 30 compressions, open Airway • Breathing • Deliver 2 breaths using BVM/Pocket Mask • Continue CPR until AED arrives Teamwork* Integrity* Professionalism* Service*

  19. AED Operations • CPR should be started immediately • On arrival of the AED, attach pads and turn it on • Do NOT delay AED implementation. • AHA CPR no longer treats witnessed –v- unwitnessed arrest differently • Continue CPR until AED arrives then analyze Teamwork* Integrity* Professionalism* Service*

  20. Attach AED to Patient Teamwork* Integrity* Professionalism* Service*

  21. Sternum-Apex Position Sternum: Right Pad is placed below the right clavicle and to the right of the Sternum above the nipple. Apex: Left Pad is placed on the lower left ribs in the midaxillary line. Teamwork* Integrity* Professionalism* Service*

  22. Electrode Placement Correct electrode position optimizes the amount of current flowing through the ventricles Correct electrode position Incorrect electrode position Teamwork* Integrity* Professionalism* Service* 22

  23. Effective Adherence of Pads Sweaty chest Dry with a towel Do not use alcohol Hairy chest Shaving may be needed Ultimate goal is to have complete skin contact. 23 Teamwork* Integrity* Professionalism* Service*

  24. Current AED Programming • Loudoun County AED’s are setup to prompt witnessed or unwitnessed arrest instructions • If the AED asks if you witnessed the arrest, push ‘CANCEL’ • This means that the AED has detected a shockable rhythm • If the AED doesn’t ask, then continue CPR as directed by the AED • This means that the AED has detected a non-shockable rhythm

  25. After pushing cancel, clear patient in preparation for a shock Teamwork* Integrity* Professionalism* Service*

  26. “I’m Clear” “You’re Clear” “Everybody is Clear” “Shocking Now” While visually checking to make sure that no one is touching patient! Teamwork* Integrity* Professionalism* Service*

  27. Shockable Rhythm • If a “Shockable Rhythm” presents (and continues to be present), administer a total of 3 shocks. Each single shock is separated by 2 minutes of CPR • Pulse Checks are to be performed when the AED indicates. Teamwork* Integrity* Professionalism* Service*

  28. “No Shock Advised” • If “No Shock is Advised”, perform two minutes of CPR , and listen for re-analyze prompt • If three “No Shocks” occur (separated by two minutes of CPR each time), contact Medical Control. • Remember “no shock advised” does not mean there is a pulse. • Pulse Checks are ONLY to be performed when the AED indicates Teamwork* Integrity* Professionalism* Service* 28

  29. If you do get a pulse, • Assess the quality of the pulse. • Assess and/or support breathing. • Check the patient’s blood pressure. • Do not turn off the AED or remove pads. • Contact medical control. Teamwork* Integrity* Professionalism* Service*

  30. Call Medical Control & Prepare to Transport ….. Three (3) shocks total delivered OR Three (3) “No Shock Advised” OR Patient regains a Pulse! Teamwork* Integrity* Professionalism* Service*

  31. While enroute ... If patient loses pulse enroute: Stop vehicle, analyze rhythm: If shock is advised: Deliver shocks, if indicated. Follow protocol. If maximum shocks reached contact Medical Control for further orders. If no shock is advised: Begin CPR Follow protocols Advise Medical Control and continue transport as may be indicated. Teamwork* Integrity* Professionalism* Service*

  32. Documentation • Field Bridge • Report assessment findings • Complete AED usage section • Make sure all fields are completed as appropriate Teamwork* Integrity* Professionalism* Service*

  33. Special Situations • Medication patches • Artificial pacemakers or Automated internal cardiac defibrillators (AICDs) • Traumatic arrests • Pediatrics Teamwork* Integrity* Professionalism* Service* 33

  34. Medication Patches • Aluminum backing or the medium is reactive. • Patch either heats up or ignites. • Expose the patient and remove ALL patches before defibrillation. • Wipe any medication off the chest. • Use gloves when you remove it. Teamwork* Integrity* Professionalism* Service*

  35. Artificial Pacemakers • Pulse generator and wires to the heart. • Usually found on the left side of the chest. • If found on the right, do not place the pad over the pacemaker. • A direct shock to the pacemaker could cause it to reprogram. Teamwork* Integrity* Professionalism* Service*

  36. Automated Internal Cardiac Defibrillator (AICD) • Used in patients with recurrent arrhythmias • If found on the right, do not place the pad on the AICD • Its presence does not preclude attaching and using an AED Teamwork* Integrity* Professionalism* Service*

  37. Trauma & Obvious Death • AED should not be attached to a patient that is obviously dead. • Signs incompatible with life, e.g. rigor mortis, etc. • Signs of injuries incompatible with life, e.g. decapitation • AED may be attached to a trauma patient in cardiac arrest since the cardiac arrest may have caused the trauma. Teamwork* Integrity* Professionalism* Service*

  38. Pediatric Patients • AED’s should be used on any patient in cardiac arrest of ANY age. • Adults include adolescents (i.e. after the onset of puberty)

  39. Pediatric Patient • Use the Lifepak1000 with adult pads on adolescents or more than 55 lbs (25kg) • Use the Lifepak1000 with Pediatric Reduced Energy Defibrillation pads/electrodes on children 55 lbs (25kg) or less. Teamwork* Integrity* Professionalism* Service* 39

  40. Pediatric Patient • With Pediatric pads/electrodes, energy from the Lifepak 1000 is reduced by a factor of 4 • Approximately 50-75-86 Joules is delivered if the Lifepak 1000 is set at 200-300-360 Joules Attenuated (reduced energy) Pediatric Pads Teamwork* Integrity* Professionalism* Service* 40

  41. Pediatric Patient • Pediatric pads supplied for the LP1000 are not compatible with the LP12 or 15. Teamwork* Integrity* Professionalism* Service* 41

  42. Pediatric Patient • Place the Pediatric pads in the sternum-apex position (same location as adult pads) Teamwork* Integrity* Professionalism* Service* 42

  43. Anterior/Posterior Position • May be used if: • Using adult pads on a pediatric patient because no pediatric pads are available • Child is small and pads will be within 1” of each other in sternum/apex position 43 Teamwork* Integrity* Professionalism* Service*

  44. LP 1000 Battery • The Lifepak 1000 is powered by a non-rechargeable lithium manganese dioxide battery pack • Battery pack fuel gauge indicates battery’s charge level • Fully charged battery: all green lights illuminated Teamwork* Integrity* Professionalism* Service* 44

  45. LP 1000 Battery • Low battery: single steady green light • Empty battery: single flashing green light Teamwork* Integrity* Professionalism* Service* 45

  46. LP 1000 Battery • The approximate level of charge in the battery appears on the readiness display when the Lifepak 1000 is off • Battery low: battery symbol has one bar • Battery empty: battery symbol has no bars • When indicating ‘LOW’, battery should not be changed in the middle of a call 46 Teamwork* Integrity* Professionalism* Service*

  47. LP 12 and 15 Batteries The LP 12 and 15 batteries are powered by a lithium ion battery that is rechargeable Battery fuel gauge indicates battery’s charge level Fully charged battery: all green lights illuminated Can be replaced when low (one at a time), and when replaced will not interrupt the operation of the AED Teamwork* Integrity* Professionalism* Service*

  48. Troubleshooting Tips • Message: “Connect electrodes” “Check connector and electrodes” • Possible causes: • Electrodes are not adhered to the patient’s skin • Electrodes are disconnected Teamwork* Integrity* Professionalism* Service* 48

  49. Troubleshooting Tips • Message: “Connect electrodes” “Check connector and electrodes” • What to do • Firmly press electrode onto the skin • Check to be sure connector is completely inserted into the AED • Clean, shave, and dry the skin • Replace the electrode pads • If prompt continues, perform CPR until ALS arrives Teamwork* Integrity* Professionalism* Service* 49

  50. Troubleshooting Tips • Message: “Motion detected, stop motion” • Possible causes: • Patient movement due to: breathing, CPR being performed during analysis, some internal pacemakers, vehicle motion, or electrical/radio frequency interference • What to do: • Check patient for normal breathing • Stop CPR during analysis • Stop vehicle during analysis • Move communication or other suspected devices away from AED when possible Teamwork* Integrity* Professionalism* Service* 50

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