Early Defibrillation and the EMT-Basic

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Early Defibrillation and the EMT-Basic

• Temple College
• EMS Professions

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Rationale

• Most frequent initial rhythm in adult cardiac
  arrest ventricular fibrillation

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Rationale

• Most effective treatment for VF defibrillation

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Rationale

• Increased VF time Decreased survival
  probability

1 minute of VF 10 decrease in
chance of survival
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Rationale

• BLS cannot convert VF to normal sinus rhythm
• BLS only increases time available to defibrillate

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Principle of Early Defibrillation

• All personnel who respond to cardiac arrests must
  be trained to operate, equipped with, and
  permitted to operate a defibrillator

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Automatic External Defibrillators
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AED Definition

• External defibrillator that incorporates rhythm
  analysis system

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AED Types
Fully Automatic
Semi- Automatic
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Operational Steps

• Assess scene, patient
• Confirm cardiac arrest
• Turn on power
• Attach device
• Initiate rhythm analysis
• Deliver shock if indicated

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Standard Procedures

• Assess scene for safety
• Water
• Explosive atmosphere
• Patient on conductive surfaces

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Standard Procedures

• Do NOT use AED if patient is
• lt 8 years old
• Weighs lt 55 pounds

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Standard Procedures

• Assess patient
• ABCs
• Presence of transdermal medication patches (nitro
  patches)
• Confirm arrest
• Unresponsive
• Apneic
• Pulseless

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Standard Procedures

• Start BLS
• Attach defibrillator
• Do NOT waste time setting up O2, suction, IVs,
  etc.
• Place pads in Lead 2 position

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Standard Procedures

• Stop CPR, analyze rhythm
• Avoid patient contact during analysis
• If machine says shock,
• Clear patient
• Deliver shock
• Immediately reanalyze

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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

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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

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Post-Resuscitation Care

• Continue to support airway, ventilation
• Supplemental O2
• Clear airway if vomiting occurs
• Monitor vitals
• Stabilize, transport, meet ACLS team

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Skill Maintenance

• Practice
• Drill at least monthly
• Rotate responsibility for checking machine

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Quality Assurance

• Case-by-case review of AED use
• Written report
• Voice/ECG recording
• Code summary tapes

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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

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Public Access Defibrillation
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Summary
Shock Early and Shock Often!