defibrillators 1. 2 defibrillators responding to sudden cardiac arrest

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Training Slides695,800
250,000
Stroke Statistics - 2003 Update. Dallas, TX.:American Heart Association;2002.
Sudden cardiac arrest is a major cause of death in the U.S. According to the American Heart Association (AHA), more than 50,000,000 Americans have one or more forms of cardiovascular disease.
Each year, more than 945,800 Americans die from cardiovascular disease.
An estimated 250,000 victims suffer sudden cardiac arrest events each year.
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1 http://www.americanheart.org
2 http://www.cancer.org
3 U.S. Statistical Abstract of the United States, 1998, Table 138.
House Fires (19981)
Prostate Cancer (20012)
Breast Cancer (20012)
Automobile Accidents (19963)
118,495
43,300
40,800
31,500
2,895
250,000
Sudden cardiac arrest (SCA) is a leading cause of death in the United States. The number of deaths from SCA is many times that of other leading causes of death.
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80% out-of-hospital
have no prior symptoms
< 5% survive
American Heart Association. Heart Disease and
Stroke Statistics - 2003 Update. Dallas, TX.:American Heart Association;2002.
In the United States, 600 people suffer sudden cardiac arrest (SCA). That’s an event every 2 to 3 minutes.
75% of all SCA takes place outside the hospital.
20% of all SCA victims have no previous symptoms like chest pain, shortness of breath, nausea or diaphoresis (sweaty) prior to suffering SCA.
Despite the best efforts of our emergency medical services (EMS) personnel, less than 5% of victims survive. Largely due to the fact that EMS can’t get there in time.
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Symptoms
Gender
Age
Risk
Factors
Medical
History
Presenting
Symptoms
It is commonly thought that typical SCA victims are old men with several risk factors.
The reality is that sudden cardiac arrest can strike anyone, anywhere at anytime.
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Recovery prospects for survivors are high
80% alive at one year
57% alive at five years
SCA deaths prevented annually*
Total SCA Events: 250,000
American Heart Association
The American Heart association estimates that 100,000 lives could be saved annually with widespread early defibrillation programs.
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An electrical event …
stimulates a mechanical event …
which results in a rhythmic and coordinated pumping action of the heart muscle
There are two components to normal heart function, electrical and mechanical.
Electrical:
Special fibers send electrical impulses in a coordinated, organized way throughout the heart.
This electrical activity is shown on an electrocardiogram (ECG or EKG).
Mechanical:
Electrical impulses stimulate heart contractions, causing the heart to pump blood--first to the lungs to receive oxygen, and then out to the rest of the body.
As a result of this coordinated electrical and mechanical heart function, the normal heart pumps with regularity and is associated with a pulse.
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Uncoordinated, very fast heart rhythm
Ventricular fibrillation (VF)
Death certain without defibrillation
Ventricular fibrillation (VF) is the most common SCA rhythm, although other rhythms are possible (ventricular tachycardia, pulseless electrical activity, and asystole).
A fibrillating heart is a quivering mass, analogous to a “bag of worms.” It is beating very rapidly, without the coordinated electrical conduction and pumping properties of a healthy heart.
The signs of SCA are unconsciousness and absence of pulse and breathing (or the presence of agonal respirations).
The only treatment that can allow the heart to reset itself to a more coordinated rhythm (and pulse) is defibrillation. Conceptually, defibrillation is similar to “rebooting” a frozen computer.
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Stops uncoordinated activity
Only effective treatment for ventricular fibrillation
Defibrillation is an electric shock delivered across the heart.
The goal of defibrillation is to stop VF, allowing a coordinated rhythm and pumping action to resume.
Defibrillation is the only effective treatment for ventricular fibrillation.
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Defibrillation an EARLY priority
The American Heart Association (AHA) “Chain of Survival” is an ideal model for response to sudden cardiac arrest (SCA).
There are four links in the chain, all of which should be activated quickly for the best outcome. The chain is only as strong as its weakest link.
Early access (call for help, including mobilizing a defibrillator to the scene)
Early cardiopulmonary resuscitation (CPR) (provide CPR until the Heartstart defibrillator arrives, and as part of defibrillator patient care)
Early defibrillation (now provided by you)
Early advanced life support (the Paramedics and other EMS personnel)
483.psd
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Chances of success are reduced 7% to 10% each minute
Time (minutes)
Cummins RO, et al. Guidelines 2000 for Cardiopulmonary Resuscitation
and Emergency Cardiovascular Care (ECC, Circulation (Suppl) 2001;102:8, August 22
For every minute that defibrillation is delayed, the chances of surviving sudden cardiac arrest (SCA) are reduced by 7-10%. Survival chances drop particularly fast in the first five minutes.
Since rapid time to defibrillation is so critical, expanding the number of early defibrillator responders offers SCA patients a real chance to survive an otherwise lethal event.
In fact, by extending defibrillation skill using defibrillators to more responders, survival rates have increased dramatically in some settings.
Two examples of the growing number of successful lay rescuer programs using Philips Defibrillators are the Chicago airport system and the resorts and casinos participating in the Clark County (Las Vegas) Fire Department’s early defibrillation program. Both have instituted early defibrillation programs that provide an estimated time from the patient’s collapse to delivery of the first shock of less than 4 minutes. The results are survival rates in excess of 50%.,
Valenzuela TD, et al. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. New England Journal of Medicine 2000;343:1206-1209.
Caffrey S, Willoughby PJ, Pepe P, Becker LB. Public use of automated external defibrillators. New England Journal of Medicine 2002;347:1242-1247.
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CPR
Defibrillation
The chart shows expected survival rates based upon when CPR and defibrillation are provided to the patient.
When defibrillation and CPR are provided within the first four minutes of SCA, the victims chance of survival is greatly increased.
Chicago’s O’Hare airport, the Rochester, Minnesota police department, and Las Vegas resorts where HeartStart defibrillators have been installed report survival rates for victims of SCA treated with the defibrillators are ten times the national average of 5 percent -- twice that of even the best EMS systems.
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*Travel time varies depending on weather, traffic, distance (vertical and horizontal), and ambulance (with defibrillator capability) availability.
**Cummins RO, et.al. Automatic external defibrillators used by emergency medical technicians: a controlled clinical trial. JAMA. 1987; 257:1605-10
Identify emergency/ Activate emergency response plan
30
seconds
1
30
seconds
2
minutes
1.1
minutes**
TOTAL
10.6
minutes
The chart breaks down the average emergency medical services response.
Many systems quote response times of 4-6 minutes. However, usually this is only the drive from the station to the location of the emergency.
The actual time from discovery to collapse is often longer than 10 minutes.
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Safe, effective,
unresponsive
Before using the HeartStart FR2+, it is important to verify that the is unresponsive and not breathing (or with agonal respirations).
The steps for determining when it is appropriate to use the FR2+ are the same steps you learned for CPR.
It is important to activate EMS or the appropriate emergency plan as soon as you determine the patient is unresponsive.
If the patient is breathing or has a pulse, HeartStart FR2+ use is not indicated.
532.psd
533.psd
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1- turning the Defibrillator on
2-applying the pads to the patient’s bare chest
3-pressing the shock button when prompted.
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unresponsive
Before using the HeartStart OnSite, it is important to verify that the patient is unresponsive and not breathing (or with agonal respirations).
The steps for determining when it is appropriate to use the OnSite are the same steps you learned for CPR.
It is important to activate EMS or the appropriate emergency plan as soon as you determine the patient is unresponsive.
If the patient is breathing, HeartStart OnSite use is not indicated.
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Pull the handle to turn on, and follow voice instructions
Place the pads to the patient’s bare chest
Press the shock button when prompted.
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Product indemnification policy
Possible reverse liability
What if the victim has a pulse and I can’t feel it?
Can I hurt someone using the defibrillator?
Is there legal liability?
OK to defibrillate on water surfaces and metal
Standard safety precautions
Using HeartStart FR2 and OnSite Defibrillators is acceptable < 8 years old with Infant/Child pads
What happens if I reverse the pads?
Can I defibrillate
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Early defibrillation programs have already demonstrated success by saving lives in a variety of environments
Sudden Cardiac Arrest DOES Happen
Las Vegas (Clark County), Nevada
On-site Early Defibrillation Programs
enhance 9-1-1 EMS systems…
Rapidly becoming a
standard of care
Early defibrillation delivered before EMS provider arrival increases the victim’s chance of survival and the overall SCA survival rate of the EMS system.
All of the national emergency care training organizations have identified defibrillation with a defibrillator as “first aid” for sudden cardiac arrest.
2,000 airport workers -- including security staff and ground crews -- have now been trained to use the devices. As of spring 2002, the Chicago airport system’s survival rate from sudden cardiac arrest with VF present at the time of rescuer arrival is 56%.
In Las Vegas, Nevada, the Clark County Fire Department has trained more than 4000 casino security personnel to use defibrillators.
In less than two years, casino personnel responded to more than 100 sudden cardiac arrest events.
Of the patients in ventricular fibrillation when the defibrillator was attached, 53% have survived to hospital discharge.
The Las Vegas and Chicago Airport experience demonstrates how early defibrillation as part of the “Chain of Survival” increases survival.
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Resuscitation and Emergency Cardiovascular Care Textbook.
“Public Access Defibrillation
single greatest advancement

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