Automated External Defibrillator

Chain of Survival Healthy Choices Recognition of the Warning Signs Early Access to EMS Early CPR Early Defibrillation Early Advanced Care Early Rehabilitation

Conduction System The heart has it’s own electrical system Impulses come from Sino-Atrial (SA) Node (natural pacemaker) Travel to the Atrio-Ventricular (AV) Node The tissue where the heart attack happens dies Impulses cannot cross the dead tissue Electrical impulses are no longer coordinated resulting in abnormal heart rhthyms

Conduction System

What is an AED Analyzes heart rhythm Generates an electric shock – if required to stop abnormal rhythm in the heart Blood is not circulating if the heart is in ventricular fibrillation or ventricular tachycardia Time from collapse to shock is critical CPR and defibrillation give the best chance of survival

The AED Instructors should ask learners to point out or to note the following: The major components of an AED: Pads to skin Pads to cables Cables to AED Point out the circuit that must be completed: skin to pads, pads to cables, cables to AED box; when troubleshooting any problems, make sure the circuit is completed. Three different types of event documentation module (solid-state memory module, standard magnetic tape microcassette, PCMCIA memory card [“flash” memory cards]) Event documentation modules record primarily 2 things: (1) voices and sounds at the scene and (2) a complex analysis of the cardiac rhythm (includes initial rhythm, interpretation by the AED Treatment Algorithm, shocks indicated, shocks delivered, response to shocks, last rhythms recorded). The proper locations for pad placement: to the patient's right upper chest, just below the clavicle. The other pad is attached on the patient's left lower anterior chest wall. The pad on the left should NOT touch the nipple The “4 universal control steps” of AED operation: Power ON Attach Analyze Shock

Types of AEDs

Operation of AEDs Power ON Attach Pads Analyze ON ANALYZE

Operation of AEDs Clear the patient !!!! “I’m clear!” “You’re clear!” “Everyone is clear!” “Shocking now”

AED Sequence 1 2 3 4 5 Check for responsiveness If unresponsive, call 911 or your local emergency number and get AED 3 Check Airway, Breathing, Circulation, (ABC) Perform CPR until AED arrives 4 Attach AED if no signs of circulation 5 Stand clear, press analyze

Shock / No Shock Protocols

Pad Placement Adult One pad – right upper chest, just below clavicle One pad – left lower anterior chest wall

Infant or Child Pad Placement Infant or pediatric pads One pad – right upper chest, just below clavicle One pad – left lower anterior chest wall Adult pads One pad – front middle of chest One pad – middle of back In the case of a child or infant where there are no child pads, use adult

Special Situations Hypothermia- follow the AED prompts, continue with CPR & handle the patient gently. Water – Wet Environments (do not use) Moving vehicles or toboggan (must be stopped) Aircraft or Helicopters (tell aircrew AED in use) Trauma Patients (not likely to work) Pregnant Patients (use as normal)

Special Situations Metal surfaces (use as normal) Patch medications (remove patch if in way) Pacemakers or implanted defibrillators (if in way- place pad at least one inch away) Oxygen (move oxygen one arm length away) Radio use (do not transmit during analyze and shock)

Who uses AEDs Healthcare providers, emergency workers, or community responders whose job or volunteer work demands that they know how to defibrillate someone Caregivers, such as family members of people who are under medical supervision due to a high risk of sudden cardiac death

Ceasing AED Sequences The patient has a pulse Another trained rescuer takes over EMS arrives It is unsafe to continue A medical doctor says to stop

Legal Aspects In some provinces/territories, the use of an AED is considered a medical act The supervising physician provides certification and medical control Follow provincial or local regulations Check with zone or division training officers on the use of AEDs in your area

Documentation Internal event recorders Patroller should complete a medical report The AED coordinator is usually responsible for ensuring for passing this information together with the medical report to the receiving hospital. Annual AED and CPR skill retention/certification