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!