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Early Defibrillation and the EMT-Basic. Temple College EMS Professions. Rationale. Most frequent initial rhythm in adult cardiac arrest: ventricular fibrillation. Rationale. Most effective treatment for VF: defibrillation. Rationale. Increased VF time = Decreased survival probability. - PowerPoint PPT Presentation
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Early Defibrillation and the EMT-Basic
Temple CollegeEMS Professions
Rationale
Most frequent initial rhythm in adult cardiac arrest: ventricular fibrillation
Rationale
Most effective treatment for VF: defibrillation
Rationale
Increased VF time = Decreased survival probability
1 minute of VF = ~10% decrease in chance
of survival
Rationale
BLS cannot convert VF to normal sinus rhythm
BLS only increases time available to defibrillate
Principle of Early Defibrillation
All personnel who respond to cardiac arrests must be trained to
operate, equipped with, and permitted to operate a defibrillator
Automatic External Defibrillators
AED Definition
External defibrillator that incorporates rhythm analysis system
AED Types
Fully Automatic
Semi- Automatic
Operational Steps
Assess scene, patient Confirm cardiac arrest Turn on power Attach device Initiate rhythm analysis Deliver shock if indicated
Standard Procedures
Assess scene for safety• Water• Explosive atmosphere• Patient on conductive surfaces
Standard Procedures
Do NOT use AED if patient is:< 8 years old
Weighs < 55 pounds
Standard Procedures
Assess patient• ABCs• Presence of transdermal medication
patches (nitro patches) Confirm arrest
• Unresponsive• Apneic• Pulseless
Standard Procedures
Start BLS Attach defibrillator Do NOT waste time setting up O2,
suction, IVs, etc. Place pads in Lead 2 position
Standard Procedures
Stop CPR, analyze rhythm Avoid patient contact during
analysis If machine says “shock,”
• “Clear” patient• Deliver shock• Immediately reanalyze
Persistent VF
3 “stacked” shocks, no pulse checks in between
If unsuccessful, 1 minute of CPR Then if no pulse present, 3 more
“stacked” shocks
Persistent VF
Always shock in sets of 3 Whenever chest is touched after
initial assessment, it should be to perform CPR for 1 minute
Continue to shock until “no shock indicated” message received
Post-Resuscitation Care
Continue to support airway, ventilation
Supplemental O2
Clear airway if vomiting occurs Monitor vitals Stabilize, transport, meet ACLS
team
Skill Maintenance
Practice• Drill at least monthly• Rotate responsibility for checking
machine
Quality Assurance
Case-by-case review of AED use• Written report• Voice/ECG recording• Code summary tapes
Quality Assurance
System• Frequency of use• Success rates• Early defibrillation may not be
effective in systems with• Long response times• No bystander CPR• Delayed ALS follow-up
Public Access Defibrillation
Summary
Shock Early and Shock Often!