Factors to Consider when using an AED

Factors to Consider when using an AED

 

When treating a victim that has gone into cardiac arrest there are a few considerations to be made when it comes to using an AED (automated external defibrillator).

These considerations need to be made on

  • Paediatric patients
  • Wet or sweaty patients
  • Patients with a hairy chest
  • Patients with a medication patch
  • Patients with a pacemaker or implantable defibrillator

 

If In doubt, start performing chest compressions and have someone contact emergency medical services via phone before you deliver an electric shock.  If there are obvious signs of a cardiac arrest, acting fast will increase the patient’s chance of survival—no matter what other factors are present.

 

Treating a Paediatric Patient

 

Cardiac arrest in children is rare but still a possibility. Child patients require a reduced electrical shock if they are under eight years old or weigh less than 55 pounds. To cater to paediatric patients, some external defibrillators have a special paediatric setting, and others come with child electrode pads (either included with the device or sold separately).

For a child under age eight, adjusting an AED can be seen in example such as the below;

  • HeartSine Samaritan PAD 350P. Unplug the adult electrode Pad-Pak and plug in the child electrode pads (sold separately). Follow the audio prompts and press the shock button when directed.

 

If no child pads are available, and your device doesn’t have a child setting, you can use standard adult pads. However, the chest placement is different for paediatric patients. One pad should be placed in the centre of the chest, and the other in the centre of the back. Use this placement for paediatric patients, whether you use adult or child pads.

See image below for reference;

For an infant under 12 months, a manual defibrillator is more appropriate than an AED (automated defibrillator) —especially if no paediatric pads are available. However, it’s much better to use a portable defibrillator (with paediatric or adult pads) than to do nothing at all.

Treating a Sweaty or Water-Submerged Patient

 

Special considerations when using an AED with a patient also apply when the patient is wet or damp from sweat. Because water is an excellent conductor of electricity, the power of the shock would be dispersed across the patient’s body and be less effective where it’s needed the most.

When treating a victim of cardiac arrest who is wet or damp, remove them from the water (if they are immersed) and take them to a dry place. Dry off their chest area as much as possible and apply the electrode pads. There is no need to completely dry the patient from head to toe as time is of the essence, focus only on completely drying the chest area, specifically the area between the pads.

The most important factor is that the victim’s chest be dry so that the shock is delivered straight to the heart. If the victim is in a puddle or lying on a wet area of the floor but their chest is dry, simply move them away from the water and use the defibrillator as normal.

 

Treating a Patient with a Hairy Chest

 

When a cardiac arrest victim has excessive chest hair, it may be difficult for the electrode pad to analyse their heart rhythm and deliver an appropriately timed shock. This is because the hair would lift the pad up and off the patient’s chest, preventing full contact with the skin. The hair would also make it more difficult for the gel on the electrode pad to adhere to the skin.

There are three main solutions to the issue of chest hair, as recommended by the American Heart Association’s Basic Life Support Manual:  BLS Provider Manual eBook (heart.org)

  1. Shave the hair off the area where the patch will be applied. It is sensible to keep a disposable razor stored with every AED specifically for this purpose. Most first-aid kids and first-responder kits should include at least one razor.
  2. If you don’t have a razor and the device continues to prompt you with “check pads,” push down hard on the electrode pads to increase conductivity. Then remove your hands when instructed to “stand clear.”
  3. If the machine still doesn’t respond, you can strip the pad quickly off the patient’s chest to remove some of the hair. Then apply a new set of pads. Only do this if you have extra pads on hand.

 

Treating a Patient with a Transdermal Medication Patch

 

Transdermal medication patches have been used since the 1970’s to deliver active medication, such as a hormone or nicotine, at a gradual rate through the skin. In the case of a cardiac arrest, medication patches present a burn hazard when using an external automated defibrillator if the shock is delivered over the patch.

Before applying an AED, remove the medication patch and wipe any sticky residue off the patient’s skin. It’s a good idea to wear gloves when removing the patch so that the medication is not absorbed through your skin.

 

Treating a Patient with a Pacemaker or Implantable Defibrillator

 

Pacemakers and implantable defibrillators make up the last category of special considerations when using an AED. If you place an AED directly over a pacemaker or defibrillator, the device may block the delivery of the shock. Instead, place the electrode pad a few inches lower or try an anterior-posterior (front-and-back) pad placement instead.

You can usually tell if a cardiac arrest victim has an implanted pacemaker or defibrillator because they will have a scar on either side of their upper chest or abdomen with a hard lump the size of a deck of playing cards or smaller. Most often this will be near the heart, on the left side of the chest, in which case it will not interfere with the standard pad placements. If they have suffered a sudden cardiac arrest, it’s almost certain that the device has stopped working. Don’t worry about damaging the device as this can be replaced.

Conclusion

With a few simple adjustments, you can use an automated external defibrillator on the patients mentioned above, as you would on any other. Make sure your AED is equipped with paediatric pads, a razor, and a pair of gloves and you should be ready for anything.

 

Special Considerations When Using an AED Device (aedleader.com)

Optimum method for defibrillation Pad Placement

Optimum method for defibrillation Pad Placement
In the event of sudden cardiac arrest (SCA), the heart is unable to pump the blood that is needed to the body’s vital organs. The heart must be shocked using an automated external defibrillator (AED) to interrupt the irregular activity and allow the heart to resume a normal cardiac rhythm.
Electrodes, otherwise known as pads, adhere to a victim’s chest and connect to the defibrillator. The pad allows the AED to determine the heart’s rhythm, and if necessary, conduct current to the heart.
 
Placing AED pads correctly is essential for ensuring that the defibrillator works properly and allows for the most direct and unobstructed path of transthoracic current (TTC). The correct placement varies between children and adults, though, and there are some unique situations where the general rules don’t apply.
 
 
   
Figure 1: Typical Child and Adult AED pad example
 
 
Figure 2: Different placement options for AEDs on adults
 

Difference between Anterior-posterior vs Anterolateral

 

There are two basic positions for AED pad placement:

  • Anterior-posterior (or “front-and-back”) placement: One on the front and one on the back.
  • Anterolateral placement: One on the right side of the chest and one on the lower part of the left chest wall (or a few centimetres below the left armpit, over the ribcage)

 

The first position is usually used on children, and the second position is used on adults. However, an anterior-posterior placement can be used on adults as well with slightly different pad placement. Instead of placing the defibrillator pads on the centre of the chest and back, place one pad just below the left nipple and the second pad on the left side of the back, directly below the scapula or wing bone.

Pad Placement on an Adult
 
According to experts, older adults are the group most likely to suffer from cardiac arrest. Although most AEDs have a child setting or are compatible with child pads, these devices typically come equipped with adult pads as the default accessory.
Generally, defibrillator kits will tell you where to place the pads on adults using both audio prompts and/or visual diagrams. However, the general rule is to position one pad over the upper right side, otherwise known as anterior-lateral of the patient’s chest, and the other on the lower left side of the patient’s chest (as shown in figure 2). This creates a pathway through the heart muscle that allows the device to shock the heart into action. Alternatively, you may choose to place pads in an anterior-posterior position, or front-back (figure 2).
 
 
Pad Placement on a Child
 
Children suffering from sudden cardiac arrest are treated in the same fashion as adults but require less energy or shock during defibrillation. The current to be delivered must be reduced, using specially designed paediatric pads.
The American Heart Association recommends that for children under 8 years old, ideally use paediatric pads so that the pads do not overlap during defibrillation. To ensure safe paediatric defibrillation, the best location for pads is the anterior-posterior (front-back) configuration (see figure 3). One electrode is placed on the front (anterior) chest wall and the other on the centre of the child’s back (posterior). They also state that anterior-lateral placement or anterior-posterior placement may be reasonable to defibrillate paediatric victims.
 
Figure 3: Pad placement for children
 
Exceptional circumstances
 
Below are a few things to look out for and what to do when you come across chest hair, a medicated patch, or wet skin.
Chest Hair
 
If the patient’s chest is quite hairy, the pads might not stick to their skin properly, jeopardising the electric shock. Before placing the pads on the patient, quickly use a razor to shave the hair where the pads will be placed. Most AED first responder kits include razors.
Wet Skin
 
Electricity and water do not mix, and neither should water and an AED. If the patient is wet, put them on a dry surface, remove their wet clothing, and get the chest dry before applying the pads.
 
Medicated Patch
 
AED pads should not be placed on top of a medicated patch, because the patch could make the electrical shock less effective. Before applying the pads, carefully remove the patch (wearing gloves) and quickly wipe the area with alcohol or a towelette.
To Conclude
 
While there are a few different things to keep in mind, AED pad placement will follow only one of two patterns—front and side or front and back. In both cases, the most appropriate position for the AED pads will be illustrated on the pads themselves and all you need to do is follow the electrode pad placement instructions. You can then deploy the AED, knowing that the shock you are administering could help in the victims’ chances of survival.
 
Sources
_________________________
www.aedleader.com
www.agajournals.org
www.heartsmart.com
www.cpr.heart.org

The Importance of knowing how to use an AED

The Importance of knowing How to Use an AED

 

In our two previous posts we have discussed both the Importance of AEDs and Importance of how to access them.

Now we delve into the Importance of knowing how use an Automated External Defibrillator.

 

The first step is to determine whether a defibrillator is actually needed. An automated external defibrillator should only be used on someone suffering sudden cardiac arrest, presenting as unconscious and not breathing. It should never be used on a patient suffering a heart attack, who is still conscious and breathing. If a person is suffering from cardiac arrest, they’ll be unresponsive without a palpable pulse, and not breathing or gasping for air.

 

Before using the AED

If someone goes into cardiac arrest, it’s important to call emergency services immediately. If multiple bystanders are available, have someone else call 9-1-1 for example in the USA and retrieve the defibrillator while you perform cardiopulmonary resuscitation (CPR). Otherwise, if no one else is around, call 9-1-1 yourself and turn on the AED.

Before using the device, the user must ensure that the scene is free from any potential accident-causing material. For example, if the sudden cardiac arrest is caused by electrocution, make sure that there’s no live wire nearby.

During cardiac arrest, the heart does not pump blood to the other organs, so organ failure can occur in just minutes. That’s why it’s important to start emergency procedures immediately while someone else calls for help. Every minute is critical.

Here are the simple steps to follow:

  1. Confirm that the patient is experiencing cardiac arrest (no breathing, unconscious).
  2. Turn on the AED and follow the audio or visual instructions relayed by the machine.
  3. Ensure the victims chest if exposed. Wipe it dry to ensure that the device sticks well to the victim’s skin.
  4. Attach the AED pads to the defibrillator and plug in the connector.
  5. All should stand clear of the patient at this point.
  6. Push the button to activate the heart rhythm analysis.
  7. If the AED device notifies you to send the electric shock, push the button to initiate the action.
  8. After delivering the shock or if shock is not recommended, administer CPR. And continue to follow the prompts from the machine.
  9. After two minutes of CPR, the AED may again prompt you to stop CPR to analyse, potentially resulting in having to administer additional shocks. Continue to follow the AED prompts, with two minutes of CPR between each analysis, until emergency services arrive.

 

 

 

Remember, an AED can save lives. That being said, learning the basic knowledge of how to administer CPR and other first aid techniques would always be an advantage in saving someone else’s life, until a professional medic arrives.

 

___________________________________

Sources

www.aedleader.com

www.ghp-news.com

 

The Importance of Access to AED’s

The Importance of Access to AED’s

If there is a situation when time is most definitely of the essence it is during a Sudden Cardiac Arrest (SCA). Cardiac arrest is the third major cause of death in the U.S., and not all people who experience sudden cardiac arrest will survive. But, having better access to an Automated External Defibrillator (AED) outside of hospital settings, will make a huge difference.

 

A SCA occurs due to an abrupt or sudden disturbance in the heart’s rhythm which results in the heart not beating or beating too little to keep a person alive. This life threatening arrhythmia or abnormal heart rhythm is called Ventricular Fibrillation (VF). In these instances, the timely use of an AED and proper application of Cardiac Pulmonary Resuscitation (CPR) can increase the chances of survival by more than 40% i.  Additionally, AED use combined with CPR increases the life-saving chances in an SCA sufferer by 75% as compared to using CPR alone. When someone suffers SCA, the survival rate declines by up to 10% with every minute that he or she is left unattended ii.

 

A SCA can happen to anybody, anywhere, and at any time, and having easy access to AED is critical in saving lives. Because of this, the U.S Food and Drug Administration (FDA) has mandated  for greater access to AEDs in public places such as airports, community centers, schools, offices, and of course, medical facilities.

 

To reinforce this mandate, the American Medical Association (AMA) also advises business owners to install AED devices in private and public structures where people converge, jobsites included iii.

 

The good thing with an AED device is that it’s made for anyone to use, not just a medic. All you need to do is open it, read the simple instructions and administer to a person in need. This way, colleagues at work, friends, or any layperson will be equipped to use an AED once they follow the instructions carefully that accompany a defibrillator.

 

This arms anyone with skills to save a life in the event of a cardiac arrest. While  prior training is not necessary, it does help to be familiar with how an AED works and how to give CPR. This is because, in an emergency situation, you may be nervous using an AED for the first time.

 

 

Part 3 coming soon: The Importance of knowing how to use an AED

 

______________________________________

i www.ghp-news.com

ii Sudden Cardiac Arrest Foundation

iii American Medical Association

 

The Importance of AED’s

The importance of AED’s (Automated External Defibrillator’s)

According to the WHO (World Health Organization), coronary heart disease is the leading cause of death worldwide, claiming the lives of more than 7 million sufferers every year. Similarly, the American Heart Association says that up to 475,000 Americans die of cardiac arrests in any given year. Out of that 475,000, more than 350,000 of these incidents are outside of hospital cardiac arrests (OHCA’s), with 90% of these reported to be fatal.

 

These alarming statistics have urged the state and federal governments to require public establishments such as workplaces, shopping centers, and other places with high traffic to have access to AED’s. The National Safety Council surmises that up to 40,000 deaths due to cardiac arrests can be prevented if this medical equipment were more accessible to the public.

 

There’s no doubt that AED’s can save lives. With that being said, what is an AED and what does it do?

 

What does an AED do? 

 

You might have seen this medical equipment in public places; an encased tool located conspicuously and in plain sight. Unlike a first aid kit, an automated external defibrillator is what you need in tackling a more serious health emergency like sudden cardiac arrest (SCA).

 

This serious health problem is often confused with a heart attack. For those who are unaware, a heart attack is caused by a blockage in the heart’s blood vessels, preventing proper blood flow and causing the heart to stop. A sudden cardiac arrest, on the other hand, is an electrical malfunction, causing an erratic blood pumping action. An abnormal heart function can trigger loss of consciousness and breathing difficulties.

 

SCA can affect anyone regardless of age, and there are rarely any warning signs. Fortunately, an AED device can be used to check a person’s heart rate and provide an electric shock to correct the malfunction, if necessary. This medical device can save lives by detecting two abnormal heart rhythm functions: Ventricular Fibrillation and Ventricular Tachycardia. Once it detects abnormal heart rate, it notifies the user to send an electric shock to restore its normal rhythm.

 

This medical device may look complicated, but it’s relatively easy to use. Apart from monitoring heart rates and delivering an electric shock, it also provides rescuers with instructions on how to perform Cardiopulmonary Resuscitation (CPR) properly.

 

CPR is defined as a lifesaving first aid procedure applied to a person whose heartbeat has stopped. It can also be performed in people who have stopped breathing, for instance, those who have been saved from drowning. The procedure aims to restore the flow of oxygen towards the brain and the body’s other vital organs.

 

Part 2 coming soon: The Importance of Access to AED’s