Post on 17-Aug-2020
Automated External
Defibrillation
DAN Paediatric Module
2/18
AED – PAEDIATRIC MODULE Objectives
• Causes of Paediatric Cardiac Arrest
• Frequency of the problem
• Reliability of the system
• AED use in children
• Paediatric Pads
• Pad Placement
• Paediatric Skills
Automated External Defibrillation Paediatric Module
3/18
AED – PAEDIATRIC MODULE Causes of Paediatric Cardiac Arrest
• Some causes of cardiac arrest in children include:
• sudden infant death syndrome (SIDS)
• trauma
• motor vehicle accident
• electrocution
• drowning
• overdose / poisoning
• illness
• congenital heart disease
• choking or airway compromise
• a hard blow to the chest has also been known to cause cardiac arrest –
as when a child is playing sports
Automated External Defibrillation Paediatric Module
4/18
AED – PAEDIATRIC MODULE Frequency of the problem
• Cardiac arrest is less common in children than adults, and its causes are more diverse
• There is very little information on what goes on in the first few minutes of a paediatric cardiac arrest
• In typical emergency care situations involving children, monitoring equipment is not attached until late in the response
Automated External Defibrillation Paediatric Module
5/18
AED – PAEDIATRIC MODULE Frequency of the problem
Automated External Defibrillation Paediatric Module
• Typical respiratory arrest treatment protocols focus on airway management and rescue breathing
• If a child moves into cardiac arrest as a result of the respiratory arrest, the focus must turn to getting the heart started again
• Airway procedures are not enough
• AEDs represent the only opportunity rescuers have to establish a normal heart rhythm prior to the arrival of advanced cardiac life support
6/18
AED – PAEDIATRIC MODULE Reliability of the System
• Researchers tested HeartStart’s Patient Analysis System on a database of 696 human paediatric rhythms for:
• Sensitivity (deciding to deliver a shock)
• Specificity (correctly deciding not to shock)
• The system recognized VF 96 percent of the time (sensitivity) and specificity was 100 percent – both well above the European Resuscitation Council (ERC) goals for AEDs
• The unit never chose to deliver a shock based on a rhythm that did not require one
Automated External Defibrillation Paediatric Module
7/18
AED – PAEDIATRIC MODULE AED use in children
Energy dose in children
• The ideal energy dose for safe and effective defibrillation is unknown
• For children 1 to 8 years of age, it is reasonable to use a pediatric dose-attenuator system if one is available. If the rescuer provides CPR to a child in cardiac arrest and does not have an AED with a pediatric attenuator system, the rescuer should use a standard AED.
Automated External Defibrillation Paediatric Module
8/18
AED – PAEDIATRIC MODULE Paediatric AED Pads
• Many manufacturers now supply purpose-made paediatric pads or programmes
• Most of them have an attenuator that automatically reduces the energy coming out of the defibrillator, delivering a lower energy shock
• For instance with a FR2+ Paediatric Pads from Philips the child receives a shock of 50 joules instead of the 150 joules delivered to adults
Automated External Defibrillation Paediatric Module
9/18
AED – PAEDIATRIC MODULE Paediatric AED Pads
If Paediatric AED pads are not available, it is acceptable – although not ideal – to use adult AED pads on a child in cardiac arrest.
You cannot use Paediatric AED pads on an adult.
Automated External Defibrillation Paediatric Module
10/18
AED – PAEDIATRIC MODULE Paediatric AED Pads
Optimal pad force
• To decrease transthoracic impedance during defibrillation, the pads should be applied firmly
Automated External Defibrillation Paediatric Module
11/18
AED – PAEDIATRIC MODULE Paediatric AED Pads
• Paediatric pads come in various colours
• Removes confusion about which pads to use on a child
• Alleviates (or reduces) concerns from the least experienced and most stressed responder
Automated External Defibrillation Paediatric Module
12/18
AED – PAEDIATRIC MODULE Paediatric Pad Placement
Automated External Defibrillation Paediatric Module
• When performed correctly both antero-posterior (A/P) and antero-lateral pad positions work equally well
• Most rescuers find it easier to use the A/P pad position when working with small children
• A/P is recommended because of the child’s small chest
Skill Development
Session
14/18
SKILL DEVELOPMENT SESSION Paediatric CPR Review
• Ensure your safety and the safety of the child • Unresponsive?
• Shout for help • Open airway
• Breathing is not normal or absent? • 5 rescue breaths • Look for signs of life • Start CPR
• 30 compressions / 2 rescue breaths • Continue CPR until signs of life:
• starts to wake up, to move, opens eyes and to breath normally
When alone go and call for help after 1 minute CPR
Skill Development Session
15/18
SKILL DEVELOPMENT SESSION Proper Pad Placement
• Place one pad vertically on the upper back, below the left scapula
• Place the second pad on the front of the child’s chest, to the left of the sternum
• Proper pad positioning and contact are very important
• Make sure pads are positioned correctly
Skill Development Session
16/18
SKILL DEVELOPMENT SESSION Providing Care with an AED
• Attach the paediatric defibrillator pads to the child and the AED
• Allow the AED to analyse heart rhythm
• Don't touch the child
Skill Development Session
17/18
SKILL DEVELOPMENT SESSION Providing Care with an AED
• If shock is required:
• Follow the AED unit’s prompts.
• Visually and physically clear the patient.
• State “I’m clear. You’re clear. All clear.”
• Administer shock.
• Resume CPR for 2 minutes. The AED will automatically reanalyse after this period
• Continue CPR and follow AED prompts until normal breathing resumes or EMS arrives
Skill Development Session
18/18
AED – PAEDIATRIC MODULE Summary
• Program rationale
• Causes of Paediatric Cardiac Arrest
• Frequency of the problem
• Reliability of the system
• Paediatric Pads
• Pad Placement
• Skills
Automated External Defibrillation Paediatric Module