Chain of Survival Early CPREarly Access Early Defibrillation Early Advanced Care
Early Defibrillation Early defibrillation is the single most important factor in determining cardiac arrest survival!!!
What is sudden cardiac arrest? The cessation of cardiac function where the patient presents with NO responsiveness, NO breathing, and NO pulse (signs of life) ventricular fibrillation ventricular fibrillation Most sudden cardiac arrest victims experience ventricular fibrillation ventricular fibrillation
What is ventricular fibrillation? The heart’s electrical signal, which normally induces a coordinated heartbeat, suddenly becomes chaotic (disorganized) Resulting in quivering of the heart’s ventricles = no or poor blood flow = decreased oxygenation to the tissues
What is ventricular fibrillation? Another condition, Ventricular Tachydardia If seen, it would look like the heart is quivering, something like a bowl of Jell-O does not allow the chambers to fill with enough blood between beats to produce sufficient blood flow to meet the body’s need, especially the brain
Non-Shockable Rhythms (defibrillation won’t help these patients) Pulseless electrical activity (PEA) 15-20% of all cardiac arrests Heart muscle fails, but the electrical activity continues Asystole (Flat line) 20-50% of all cardiac arrests The heart has ceased generating electrical impulses altogether Remember the longer you go without defibrillation, the lower the patient’s chance of survival
Why is the AED so important? CPR alone will NOT reverse ventricular fibrillation Remember, CPR only provides 30% of the normal blood flow to the brain EARLY defibrillation is the single most important factor in survival from sudden cardiac arrest caused by ventricular fibrillation!!!!!
How an AED works Contains a microprocessor and a computer program Distinguishes the electrical activity of the heart Intended to disrupt the abnormal electrical activity of V-fib and V-tach long enough to allow the heart to spontaneously develop an effective rhythm on it own Used for victims in cardiac arrest ONLY!!!
Types of AEDs Semiautomatic Requires the rescuer to shock the victim Fully automatic Shocks automatically
AED Maintenance AED’s do not require a high degree of maintenance Usually will indicate when service is required
When To Use An AED Victim must meet four conditions 1. Unresponsive 2. No breathing 3. No pulse 4. Chest dry (if not, wipe dry)
Special Situations Care should be taken with individuals wearing medication patches or those with pacemakers or defibrillators Adequately dry the chest; if in a wet environment, try to keep as dry as possible If an implantable device is used, do not place the AED pads directly on the device, rather move them accordingly If the victim is hypothermic, check for signs of life for 30-45 s. Do not delay CPR or defibrillation to re-warm the victim If a victim has suffered a trauma, the AED may still be used; however, the AED should be used according to the local protocols If pediatric pads are not available, you may use adult pads
Pad Placement Remember you have adult and pediatric pads 1. Remove the pads from the packaging and connect cables from the AED to the pads or the cables to the AED 2. Wipe the victim’s chest dry 3. Peel away protective plastic backing from the pads 4. Place one pad (white) on the upper-right side of the victim’s chest, above the nipple and below the collarbone 5. Place other pad (red) around the lower-left side of the victim’s chest, below the nipple
Using the AED 1. Confirm cardiac arrest, check the victim for signs of life for no more than 10 seconds 2. Turn on the AED; follow the unit’s directions 3. Let the AED analyze the heart rhythm by pushing the analyze button 4. Advise rescuers to “stand clear” 5. Deliver the shock by pushing the shock button when indicated
Using the AED 6. After the first shock is delivered, begin CPR immediately 7. Continue with CPR for 2 minutes if the shock delivered does not resuscitate the victim 8. Analyze after two minutes of care
AED Precautions 1. Don’t touch the victim while the AED is analyzing/defibrillating 2. Don’t use alcohol to wipe the victim’s chest dry or use an AED around other flammable materials 3. Don’t use around flammable materials, such as gas or flowing oxygen 4. Don’t use an AED in a moving vehicle 5. Don’t use an AED on a victim lying on a conductive surface 6. Don’t use an AED on a victim wearing a nitroglycerin patch or other patch on the chest 7. Don’t use a cellular phone or radio transmitter with 6 feet of the AED 8. Use age-appropriate pads when available
References 1. National Safety Council. (2001). First aid and CPR (4 th ed.). Boston: Jones and Bartlett Publishing. 2. Limmer, D., O ’ Keefe, M. F., Grant, H. D., Murray, R. H., & Bergeron, J. D. (2001). Emergency care (9 th ed). Upper Saddle River, NJ: Prentice Hall. 3. American Red Cross. (2001). Emergency response. Boston: The American National Red Cross. 4. American Heart Association (2001). Fact sheet: Community Access to Emergency Defibrillation Act of 2001. [Online]. Available at: http://www.amhrt.org/downloadable/heart/1016547403803comm unity%20AED.pdf