Loudoun County AED Program
description
Transcript of Loudoun County AED Program
Loudoun County AED Program
Rev. 11/20131
AEDAED AEDAEDTeamwork* Integrity* Professionalism* Service*
Objectives
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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
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.”
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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.
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Electrical Pathway
• Sinoatrial Node (SA)
• Atrioventricular Node (AV)
• Bundle of His
• Bundle Branches
• Purkinje Fibers
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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.
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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).
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Shockable Rhythms
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Ventricular Fibrillation
Pulseless Ventricular Tachycardia
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The absence of any electrical impulse is called AsystoleAsystole
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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.
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AEDs used by Loudoun County
Fire & Rescue Companies
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Lifepak 1000 Lifepak 12
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Lifepak 15
All units are biphasic
AED Components/Accessories
Battery
Microprocessor/Charging Unit
Pads & Cables
Extra pads
Razor
Wash cloth
Spare batteries & Paper (for LP 12/15)
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Laerdal Heart Stream
Found in Purcellville Police vehicles
.
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Purcellville Town Administration Middleburg Town and Police
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Pads are not compatible with Medtronic (Lifepak) units
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
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Indications for Use
• Standing Order – Cardiac Arrest
Pulseless and Apneic
Regardless of age (from birth)
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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
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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!
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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
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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
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Attach AED to Patient
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Sternum-Apex Position
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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.
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Electrode Placement
Correct electrode position optimizes the amount of current flowing through the ventricles
Correct electrode position Incorrect electrode position
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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.
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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 rhythm24
After pushing cancel, clear patient
in preparation for a shock
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“I’m Clear”
“You’re Clear”
“Everybody is Clear”
“Shocking Now”
While visually checking to make sure that no one
is touching patient!
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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 Pulse Checks are to be performed when the
AED indicatesAED indicates. .
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“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 Remember ““no shock advisedno shock advised”” does not mean does not mean there is a pulse.there is a pulse.
• Pulse Checks are ONLY to be performed when Pulse Checks are ONLY to be performed when the AED indicatesthe AED indicates
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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.
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Call Medical Control & Prepare to Transport …..
Three (3) shocks total delivered
OR
Three (3) “No Shock Advised”
OR
Patient regains a Pulse!
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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
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Documentation
•Field Bridge• Report assessment findings• Complete AED usage section•Make sure all fields are
completed as appropriate
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Special Situations
• Medication patches
• Artificial pacemakers or Automated internal cardiac defibrillators (AICDs)
• Traumatic arrests
• Pediatrics
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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.
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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.
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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
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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
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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)
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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.
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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
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Attenuated (reduced energy) Pediatric Pads
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Pediatric Patient
• Pediatric pads supplied for the LP1000 are not compatible with the LP12 or 15.
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Pediatric Patient
• Place the Pediatric pads in the sternum-apex position (same location as adult pads)
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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
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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
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LP 1000 Battery
• Low battery: single steady green light
• Empty battery: single flashing green light
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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
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LP 12 and 15 Batteries
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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 illuminatedCan be replaced when low (one at a time), and when replaced will not interrupt the operation of the AED
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Troubleshooting Tips
• Message: “Connect electrodes” “Check connector and electrodes”
• Possible causes:• Electrodes are not adhered to the patient’s
skin• Electrodes are disconnected
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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
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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
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Troubleshooting Tips
• Message: “Replace battery”
• Possible causes:• Battery pack has exceeded specified
“on time” and/or energy discharges
• What to do:• LP 1000-Continue to use during
resuscitation• LP 12/15-Obtain a replacement battery
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Maintenance• Daily Auto Test (LP 1000 only)
• The Lifepak1000 performs automatic tests daily at 3:00 AM
• OK symbol visible: AED is ready for use• Daily auto test will test for low or replace
battery conditions• Battery gauge on the readiness display
updates every day
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Maintenance
• Self-test• Each time the Lifepak 1000 is manually
turned on, it performs internal self-tests to check that the internal electrical components and circuits work properly
• Also indicates a low or replace battery condition
• LP 12/15 does not provide this option
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Maintenance
• If the Lifepak 1000 requires service, the wrench symbol appears
• If the wrench is visible, remove the Lifepak 1000 from service and contact authorized service personnel
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After-use Care
After the AED has been used:• Clean off foreign substances• Replace electrodes• Replenish supplies as needed• Check battery symbol for battery status
and replace battery if low
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Routine Maintenance• On a periodic basis check the following:
• OK symbol/battery gauge level is visible on LP1000
• Battery gauge level on LP 12/15• Use-by date on electrode pads is not passed• Other emergency supplies stored with the
unit are present (e.g., face masks, gloves, razors, etc.)
• Damage to or foreign substances
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Questions or Questions or Comments?Comments?
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