Loudoun County AED Program Rev. 11/2013 1 AED AED Teamwork* Integrity* Professionalism* Service*

Loudoun County AED Program

Rev. 11/20131

AEDAED AEDAEDTeamwork* Integrity* Professionalism* Service*

Objectives

2Teamwork* Integrity* Professionalism* Service*

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.”


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.


Electrical Pathway

• Sinoatrial Node (SA)

• Atrioventricular Node (AV)

• Bundle of His

• Bundle Branches

• Purkinje Fibers


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.


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).


Shockable Rhythms

8

Ventricular Fibrillation

Pulseless Ventricular Tachycardia

Teamwork* Integrity* Professionalism* Service*

The absence of any electrical impulse is called AsystoleAsystole


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.


AEDs used by Loudoun County

Fire & Rescue Companies

11

Lifepak 1000 Lifepak 12


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)


Laerdal Heart Stream

Found in Purcellville Police vehicles

.

13

Purcellville Town Administration Middleburg Town and Police


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


Indications for Use

• Standing Order – Cardiac Arrest

Pulseless and Apneic

Regardless of age (from birth)


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

Teamwork* Integrity* Professionalism* Service* 16

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!


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


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


Attach AED to Patient


Sternum-Apex Position

21

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.


Electrode Placement

Correct electrode position optimizes the amount of current flowing through the ventricles

Correct electrode position Incorrect electrode position


2323

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.


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


26

“I’m Clear”

“You’re Clear”

“Everybody is Clear”

“Shocking Now”

While visually checking to make sure that no one

is touching patient!


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. .


“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

Teamwork* Integrity* Professionalism* Service*28

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.


Call Medical Control & Prepare to Transport …..

Three (3) shocks total delivered

OR

Three (3) “No Shock Advised”

OR

Patient regains a Pulse!


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

may be indicated.31Teamwork* Integrity* Professionalism* Service*

Documentation

•Field Bridge• Report assessment findings• Complete AED usage section•Make sure all fields are

completed as appropriate


Special Situations

• Medication patches

• Artificial pacemakers or Automated internal cardiac defibrillators (AICDs)

• Traumatic arrests

• Pediatrics


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.


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.


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


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

may have caused the trauma.37Teamwork* Integrity* Professionalism* Service*

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)

38

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.


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


Attenuated (reduced energy) Pediatric Pads

40

Pediatric Patient

• Pediatric pads supplied for the LP1000 are not compatible with the LP12 or 15.


Pediatric Patient

• Place the Pediatric pads in the sternum-apex position (same location as adult pads)


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


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


LP 1000 Battery

• Low battery: single steady green light

• Empty battery: single flashing green light


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


LP 12 and 15 Batteries

47

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


Troubleshooting Tips

• Message: “Connect electrodes” “Check connector and electrodes”

• Possible causes:• Electrodes are not adhered to the patient’s

skin• Electrodes are disconnected



• 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



• 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



• 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


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


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


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


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


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


Questions or Questions or Comments?Comments?


Documents

Loudoun County AED Program Rev. 11/2013 1 AED AED Teamwork* Integrity* Professionalism* Service*