Transcript Document

USING AN AED
Ashland Community
And Technical College
Presented by Bob Chaffins
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Introduction
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CARDIAC CHAIN OF SURVIVAL
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Early recognition and early access
Early CPR
Early defibrillation
Early advanced life support.
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Introduction
An automated external defibrillator (AED)
is a machine that analyzes the heart’s
rhythm and, if necessary, tells you to
deliver a shock to the victim of sudden
cardiac arrest.
 The following video segment demonstrates
how to use an AED alone and how to use
an AED when CPR is already in progress.
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KEY POINTS
Most cardiac arrests occur away from a
hospital. The care needed to immediately
correct the cardiac arrest condition is not
readily available.
 Prompt CPR can help a cardiac arrest
victim but is insufficient to correct the
underlying heart problem.
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KEY POINTS
An electric shock is needed to correct the
problem in more than two thirds of all
cardiac arrests.
 The sooner the shock is administered, the
greater the likelihood of survival.

– This shock is known as defibrillation.
– For every minute defibrillation is delayed,
chances of survival are reduced 10%.
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PHYSIOLOGY
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Specialized cells of the heart initiate and carry on
electrical activity. These cells make up what is
commonly called the conduction system.
The conduction system can be thought of as a
pathway or road that electrical impulses must
travel.
Under normal conditions, this impulse causes the
ventricles to contract and forces blood out of the
heart to circulate through the body.
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PHYSIOLOGY
The electrical activity of the heart can be
evaluated by a cardiac monitor.
 A regular rhythm that occurs within a
normal rate, 60-100 beats per minute
(bpm), and without unusual variations, is
called a normal sinus rhythm.
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PHYSIOLOGY
Disease or injury can disrupt the
conduction system and damage the heart.
This disruption can result in an abnormal
heart rhythm that can stop circulation.
 Ventricular tachycardia (V-tach) and
ventricular fibrillation (V-fib) are the most
common abnormal rhythms, initially seen
in cardiac arrest victims. V-tach often
quickly deteriorates to V-fib.
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PHYSIOLOGY
V-fib is a state of totally disorganized
electrical activity in the heart.
 It results in the fibrillation, or quivering, of
the ventricles.
 It is not adequate for the ventricles to
pump blood.
 V-fib and V-tack can be corrected by
defibrillation.
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PHYSIOLOGY
Rapid defibrillation is the major
determinant of survival for these victims.
 This is where the importance of the AED
access is invaluable.
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DEFIBRILLATION
During defibrillation, an electrical shock is
delivered to the heart.
 Defibrillation is not intended to start a
dead heart, one without any electrical
activity (Asystole).
 Defibrillation is intended to disrupt the
abnormal electrical activity of V-fib or Vtach long enough to allow the heart to
spontaneously develop an effective rhythm
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DEFIBRILLATION
If not corrected, these rhythms will
deteriorate to the point where all electrical
activity will cease, a condition known as
asystole.
 Asystole is not corrected by defibrillation.
 It indicates a dead heart, unlikely to be
resuscitated.
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DEFIBRILLATION
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AEDs are automatic devices used by first
responders. They –
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Require less training
Are less expensive.
Are easier to use
They enable first responders to rapidly initiate
lifesaving defibrillation to cardiac arrest
victims rather than waiting for more advanced
personnel to arrive by ambulance.
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CPR
CPR, begun immediately and continued
until defibrillation is available, will help
prolong V-fib so that it can be corrected by
defibrillation.
 CPR also appears to contribute to
preserving brain function.
 CPR alone cannot maintain V-fib
indefinitely nor convert V-fib to a normal
sinus rhythm.
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PRECAUTIONS
AED training devices should never be
connected to humans – only manikins.
 Live AEDs should never be used for
training and never connected to a human
for training.
 Carefully follow the manufacturer’s
instructions for proper de-activation of
AEDs used in training.
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PRECAUTIONS
Treat the AED trainers with respect and do
not allow horseplay involving such.
 Treat the manikins as if they are actual
victims.
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PRECAUTIONS
Ensure all AED precautions are followed
during the class, including, but not limited
to the following:
 Do not use alcohol to wipe the victim’s
chest dry. Alcohol is flammable.
 Do not use an AED on a victim in contact
with water.
 Do not use an AED on a victim lying on a
conductive surface.
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PRECAUTIONS
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Do not touch the victim while the AED is
analyzing.
Do not defibrillate someone around flammable
materials, such as gasoline or free flowing
oxygen.
Do not use a cell phone or radio within 6 feet of
the AED. This may interrupt analysis.
Remove all jewelry from the victim’s chest.
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PRECAUTIONS
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Do not touch the victim while defibrillating. You
or someone else could get shocked.
Do not use an AED in a moving vehicle.
Movement may affect the analysis.
Do not use an AED on an infant.
Use the AED on a child under age 8 or under 55
pounds only if you are using pediatric pads or an
AED modified for child use only.
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PRECAUTIONS
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Do not us an AED on a victim who has a
nitroglycerin or other patch. With a gloved
hand, remove any patches from the chest
before attaching the device.
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Frequently Asked Questions
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If the location of the pads on the chest is
reversed, will the AED still work?
– YES. If the placement of the pads is reversed,
the AED will still work.
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Frequently Asked Questions
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Should the pads be removed when the
AED prompts “no shock advised, continue
CPR”?
– NO. The pads should not be removed. It is
possible that the AED will tell you that
additional shocks are needed.
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Frequently Asked Questions
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Are there any special considerations when
placing electrode pads on a female victim?
– If the victim is wearing a bra, remove it before
placing the electrode pads. Place one
electrode pad on the victim’s upper right chest
(white on right) and one on the lower left side
(red on rib), under the victim’s left breast.
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Frequently Asked Questions
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Do AEDs need regular maintenance?
– YES. All AEDs need to be maintained on a
regular basis. Maintenance includes checking
and changing batteries and electrode cables
and pads. Always follow the manufacturer’s
instructions for maintenance of the AED at
your worksite.
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Frequently Asked Questions
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Can AEDs be used safely in the rain and snow?
– YES. It is safe to use AEDs in all weather conditions.
However, if at all possible, move to shelter to keep the
victim protected from inclement weather. If the
victim is lying in water, move him or her to a
relatively dry area before using the AED. In wet
weather, dry the victims chest before placing the
electrode pads.
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Frequently Asked Questions
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Can an AED be used on a young child or
an infant?
– NO. Use of an AED is not recommended for
an infant or child younger than 8 years old or
under 55 pounds. For an infant or child
younger than 8 years old or under 55 pounds,
initial priority of care is CPR.
– Child defibrillators are now becoming
available.
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Frequently Asked Questions
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Can I defibrillate a pregnant woman?
– YES. Defibrillation shocks transfer no
significant electrical current to the fetus.
Local protocols/medical direction should be
followed.
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SKILL (5 basic steps)
Confirm cardiac arrest (unresponsive, not
breathing, pulseless).
 Turn on the device.
 Attach the device to the victim.
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– Dry the chest first with gauze.
Analyze the rhythm.
 Deliver a shock, if indicated.
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SKILL
Apply the emergency action steps:
CHECK, CALL, CARE.
 Apply basic precautions to reduce the risk
of disease transmission. (BSI) Use
disposable gloves and a breathing barrier.
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SKILL
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(basics)
When an AED becomes available –
– Turn on the AED
– Apply the pads. Dry the chest first with gauze.
– Let the AED analyze the victim’s heart rhythm (or
push “analyze” if needed)
– Deliver a shock when prompted
– Make sure no one is touching the victim when the
AED is analyzing.
– Make sure no one is touching the victim before a
shock is given.
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USING THE AED
Once turned on, AEDs are capable of
recording the events in the care of the
victim.
 Attach the device to the victim by applying
two adhesive pads to the victim’s chest.
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– White on right
– Red on ribs.
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USING THE AED
Ensure that the chest is bare and dry.
 Remove the pads from their packaging.
 Connect the two cables from the AED to
the pads if necessary.
 Peel away the protective plastic backing
from the pads
 Place the pads, adhesive-side down, on the
victims chest, according to manufacturer’s
directions.
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USING THE AED
If the pads are not securely attached to the
chest, or if the cables are not fastened
properly, you will receive an “error” or “no
contact” message.
 Analyze the heart rhythm.
 Stand clear of the victim. (Verbalize)
 Press the button marked “analyze” if
needed to have the AED examine the heart
rhythm.
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USING THE AED
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Allow the machine to analyze the rhythm for
several seconds.
The AED will notify you by an on-screen
message or voice prompt if it detects a rhythm
that should be defibrillated.
Stand clear of the victim. (Verbalize)
The AED will charge to the appropriate energy
level and deliver a shock automatically. Some
devices require the operator to do so by pressing
a button.
The heart will not always need defibrillation. The
device will inform you if no shock is needed.
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USING THE AED
Deliver one shock.
 Re-analyze the rhythm.
 Continue two minutes of CPR and repeat
this cycle.
 The heart will not always indicate a shock.
 Recheck the victim’s pulse. If it is still
absent, perform two minutes of CPR.
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Summary
Prompt CPR can help a cardiac arrest
victim, but is insufficient to correct the
underlying heart problem.
 An electric shock is needed to correct the
problem in more than two thirds of all
cardiac arrests. This shock is known as
defibrillation.
 Defibrillation is not intended to start a
heart, on without electrical activity.
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Summary
AEDs are effective at helping to save the
lives of victims of cardiac arrest.
 You should follow the 5 basic steps for use
of an AED.
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Confirm cardiac arrest.
Turn on the device.
Attach the device to the victim.
Analyze the rhythm.
Deliver a shock, if indicated.
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Scenario
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You are at work taking a break when you
find a co-worker who appears to be
unconscious. No one else standing around
knows CPR or how to use an AED, but an
AED is nearby.
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Scenario
cont.
Participant action
 Check
 Victim is unconscious
 Participant action
 Instructs someone to call emergency
number and retrieve AED.
 Participant action
 Victim is not breathing
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Scenario
cont.
Provides two breaths
 Participant action
 Check for circulation
 No pulse
 Participant action
 Gives CPR
 3 cycles and AED arrives
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Scenario
cont.
Gives 1 shock
 Participant action
 Reanalyze rhythm
 Participant action
 Gives CPR for 2 minutes if indicated
 Participant action
 Analyze and shock 1 time
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Scenario
cont.
Participant action
 Checks pulse and breathing
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Pulse and breathing restored.
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Examination
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Early defibrillation is an important link in
the cardiac chain of survival because –
– Each minute that defibrillation is delayed
reduces the victim’s chance of survival.
– Defibrillation can help prevent stroke
– A cardiac arrest victim may have an unshockable rhythm
– All of the above
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Examination
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Where should you attach the AED pads to
the victim?
– One on the center of the chest and one on the
lower abdomen
– One on the lower left side and one on the
lower right side
– One on the upper right chest and one on the
lower left side.
– Both pads on the upper chest
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Examination
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Which of the following precautions apply
when using an AED?
– Do not touch the victim while the AED is
analyzing
– Do not touch the victim when defibrillating
– Do not use an AED on a victim lying on a
conductive surface
– All of the above.
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Examination
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Before delivering a shock with an AED
you should –
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Do a finger sweep
Place the victim on his or her side
Have another responder hold the victim
Instruct others to stand clear.
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Examination
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You are giving care to a victim with no
pulse. After you give 2 shocks the AED
prompts, “No shock advised”. What action
should you take next.
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Check for a pulse.
Push the shock button anyway
Start CPR
Give 2 slow breaths
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Examination
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If CPR is not started, how long after
cardiac arrest will the brain begin to die?
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Immediately
2-4 minutes
4-6 minutes.
8-10 minutes
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Examination
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Which is the primary sign of cardiac
arrest?
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No breathing
Absence of a pulse.
Absence of blood pressure
Dilation of the pupils
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Examination
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What should you do if a victim’s breathing and
pulse return while caring for cardiac arrest.
– Have a bystander transport you and the victim to the
hospital
– Continue rescue breathing while waiting for advanced
medical personnel to arrive.
– Complete a secondary survey before calling advanced
medical personnel
– Keep the airway open and monitor vital signs until
advanced medical personnel arrive.
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Where to Get More Information
Ashland Community & Technical College
4818 Roberts Drive
Ashland, KY 41102
Bob Chaffins
606-326-2478
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