rev. dec 121 loudoun county aed program aed aed teamwork* integrity* professionalism* service*

Rev. Dec 12Rev. Dec 12 11

Loudoun County AED Loudoun County AED ProgramProgram

AEDAED AEDAEDTeamwork* Integrity* Professionalism* Service*

ObjectivesObjectives

Rev. Dec 12Rev. Dec 12 22Teamwork* 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


DefinitionDefinition

““Defibrillation is the delivery of an Defibrillation is the delivery of an electric current through the chest electric current through the chest wall and heart for the purpose of wall and heart for the purpose of terminating ventricular fibrillation or terminating ventricular fibrillation or pulseless ventricular tachycardia and pulseless ventricular tachycardia and restoring a perfusing rhythm.”restoring a perfusing rhythm.”

Teamwork* Integrity* Professionalism* Service*

44

A & P of the HeartA & P of the Heart

A network of specialized tissue, capable of A network of specialized tissue, capable of conducting electrical current, runs conducting electrical current, runs throughout the heart muscle.throughout the heart muscle.

As electrical impulses travel through this As electrical impulses travel through this network, coordinated contractions of the network, coordinated contractions of the heart muscle occur.heart muscle occur.

Rev. Dec 12Rev. Dec 12 Teamwork* Integrity* Professionalism* Service*


Electrical PathwayElectrical Pathway

Sinoatrial Node (SA)Sinoatrial Node (SA) Atrioventricular Node Atrioventricular Node

(AV)(AV) Bundle of His Bundle of His Bundle BranchesBundle Branches Purkinje FibersPurkinje Fibers



Heart FunctionHeart Function Electrical

Electrical impulses through the heart.

Evaluated with ECG monitor.

An electrical rhythm does not mean there is a pulse!

MechanicalMechanical Actual pumping of Actual pumping of

the heart.the heart.

Evaluated by Evaluated by checking pulse.checking pulse.



Shockable RhythmsShockable 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 RhythmsShockable Rhythms

Ventricular Fibrillation

Pulseless Ventricular Tachycardia



The absence of any electrical impulse is The absence of any electrical impulse is

called called AsystoleAsystole



AEDs and Ventricular Fibrillation/AEDs and Ventricular Fibrillation/Pulseless Ventricular TachycardiaPulseless Ventricular Tachycardia

Defibrillation “shocks” the heart in an effort to Defibrillation “shocks” the heart in an effort to

restore normal electrical activity of the heart.restore normal electrical activity of the heart.

Defibrillation is the only effective treatment for Defibrillation is the only effective treatment for

VF/Pulseless VT, once the patient’s pump has been VF/Pulseless VT, once the patient’s pump has been

primedprimed

The ability to successfully defibrillate a patient into

a normal rhythm diminishes rapidly over time.



AEDs used by Loudoun County AEDs used by Loudoun County Fire & Rescue CompaniesFire & Rescue Companies

Lifepak 1000 Lifepak 12


Lifepak 15


AEDAED Components/AccessoriesComponents/Accessories

AED with BatteryAED with Battery Pediatric and Adult Pediatric and Adult

PadsPads Razor Wash cloth Spare batteries &

Paper (for LP 12 only)



Authorized Use of AEDAuthorized Use of AED

Granted to locally authorized FR, EMT, Granted to locally authorized FR, EMT, Advanced EMT, I/PAdvanced EMT, I/P

Active member of OEMS EMS Licensed Agency Active member of OEMS EMS Licensed Agency authorized to operate in Loudoun Countyauthorized to operate in Loudoun County

Current BLS – AHA Healthcare ProviderCurrent BLS – AHA Healthcare Provider

Recertification every 12 monthsRecertification every 12 months


Rev. Oct 09Rev. Oct 09 1414

Indications for UseIndications for Use

Standing Order – Cardiac Standing Order – Cardiac Arrest Arrest Pulseless and Apneic of any Pulseless and Apneic of any age age


Presumptive Death (DOA)Presumptive Death (DOA) CriteriaCriteria

DecompositionDecomposition Lividity or dependent pooling of bloodLividity or dependent pooling of blood Obvious mortal injury that is inconsistent with lifeObvious mortal injury that is inconsistent with life Rigor mortisRigor mortis Presence of a Virginia Durable Do Not Presence of a Virginia Durable Do Not

Resuscitate (DDNR) orderResuscitate (DDNR) order If in doubt, begin resuscitation and contact If in doubt, begin resuscitation and contact

medical control for guidancemedical control for guidance

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Rev. Decd 12Rev. Decd 121616

Scene Safety/BSIScene Safety/BSI

Make sure that the environment is Make sure that the environment is safe.safe.

Is the patient laying in water?Is the patient laying in water?

Do you need to move the patient Do you need to move the patient before starting care?before starting care?

It is not safe to defibrillate in a It is not safe to defibrillate in a moving ambulance!moving ambulance!



CPR ProcedureCPR Procedure Patient is found pulseless and apneic Patient is found pulseless and apneic

or unresponsive:or unresponsive: Procedures:Procedures:

Look for signs of breathing…if none Look for signs of breathing…if none perform a pulse check for 5-10 seconds, if perform a pulse check for 5-10 seconds, if no pulse start CPR w/ compressionsno pulse start CPR w/ compressions

Perform CPR while attaching AED patchesPerform CPR while attaching AED patches Turn on AED and analyze rhythm Turn on AED and analyze rhythm

immediatelyimmediately


Two Possible ScenariosTwo Possible Scenarios

Shockable RhythmShockable Rhythm After shock, immediately resume CPRAfter shock, immediately resume CPR Switch providers for compressions along Switch providers for compressions along

with analyzingwith analyzing Must have 3 consecutive prior to transportMust have 3 consecutive prior to transport

Non-shockable RhythmNon-shockable Rhythm Must have 3 consecutive prior to transportMust have 3 consecutive prior to transport

Rev. June 08Rev. June 08 1818


“I’m Clear”

“You’re Clear”

“Everybody is Clear”

“Shocking Now”

While visually checking to make sure that no one

is touching patient!



Attaching AED to PatientAttaching AED to Patient



Effective Adherence of PadsEffective 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.



Sternum-Apex PositionSternum-Apex PositionSternum:

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 PlacementElectrode Placement Correct electrode position optimizes the Correct electrode position optimizes the

amount amount of current flowing through the ventriclesof current flowing through the ventricles

Correct electrode position Incorrect electrode position

Teamwork* Integrity* Professionalism* Service*Rev. Dec 12Rev. Dec 12 23

Pediatric PatientPediatric Patient

Use the AED1000 with adult pads on children older than 8 years old or more than 55 lbs (25kg)

Use the AED 1000 with Pediatric Reduced Energy Defibrillation Pads on children 1 to 8 years old or 55 lbs (25kg) or less.

Rev. Dec 12Rev. Dec 12 Teamwork* Integrity* Professionalism* Service* 24

Pediatric PatientPediatric Patient With Pediatric Pads, energy from the

AED 1000 is reduced by a factor of 4 Approximately 50-75-86 Joules is

delivered if the AED1000 is set at 200-300-360 Joules

Rev. Dec 12Rev. Dec 12 Teamwork* Integrity* Professionalism* Service*

Attenuated (reduced energy) Pediatric Pads

25

Pediatric PatientPediatric Patient Pediatric pads supplied for the LP1000

are not compatible with the LP12 or 15.


Pediatric PatientPediatric Patient

Place the Pediatric pads in the anterior-lateral position (same locations has adult pads)

Rev. Oct 09Rev. Oct 09 Teamwork* Integrity* Professionalism* Service* 27

Anterior/Posterior PositionAnterior/Posterior Position May be used if: May be used if:

Adult pads on a pediatric patient if no Adult pads on a pediatric patient if no pediatric pads are avail pediatric pads are avail

Child is small and pads will be within 1” of Child is small and pads will be within 1” of each othereach other


Medtronic Medtronic

LifePak 12 or 15LifePak 12 or 15

Rev. Oct 09 Teamwork* Integrity* Professionalism* Service* 29


CONNECT ELECTRODES message and voice prompt occur until the patient is connected to the therapy cables

Clear patient than push analyze button


After confirming a After confirming a Cardiac Arrest turn AED Cardiac Arrest turn AED onon


Do not touch or move the patient or therapy cables during analysis.The AED requires 6-9 seconds to fully analyze the patient’s rhythm

Allow machine to complete the analysisNever override the machine



Allow machine to charge Do not over ride system

Say “I’m clear”

“Your clear”

“Everyone’s clear”

“Shocking now”

Prior to pushing the shock button



Lifepak has identifies an non-shockable rhythm

Check carotid artery

AED will count down 2 minutes of CPRDo not override the countdownPush Analyze when prompted


MedtronicMedtronic

Lifepak 1000Lifepak 1000

34Teamwork* Integrity* Professionalism* Service*Rev. Dec 12

Lifepak 1000 OperationsLifepak 1000 Operations Confirm Cardiac Arrest Turn on AED Attach Pads AED will immediately began to analyze If AED detects a shockable rhythm machine will

ask “If you witnessed the arrest push cancel” If AED has detected a non-shockable rhythm no

prompt will be given start CPR for 2 minutes Follow prompts of the machine

Rev. Dec 12 Teamwork* Integrity* Professionalism* Service* 35

Check for PulseCheck for Pulse You may be prompted to check for a

pulse after a no shock advised decision.

YES and NO soft keys appear on the screen

If patient does not have a pulse, press the NO soft key and CPR time begins

If patient has pulse, press the YES soft key The 1000 will prompt the user to provide rescue breaths, if needed

The 1000 enters continuous monitoring state



If you do get a pulse, If you do get a pulse, Assess the quality of the pulse. Assess the quality of the pulse.

Assess and/or support breathing.Assess and/or support breathing.

Check the patient’s blood pressure.Check the patient’s blood pressure.

Do not turn off the AED or remove

pads.

Contact medical control.Contact medical control.



Call Medical Control & Call Medical Control & Prepare to Transport …..Prepare to Transport …..

Maximum of 3 shocks Maximum of 3 shocks with 2 minutes of CPR with 2 minutes of CPR between shocks are between shocks are delivered*.delivered*.

Three (3) “No Shock Three (3) “No Shock Advised” scenariosAdvised” scenarios

Patient regains a Pulse!Patient regains a Pulse!



While enroute ...While enroute ...If patient loses a pulse enroute…If patient loses a pulse enroute…

STOP AMBULANCESTOP AMBULANCE ReanalyzeReanalyze Continue with procedures as usualContinue with procedures as usual Contact receiving hospital with updated Contact receiving hospital with updated

informationinformation


Rev. Dec 12Rev. Dec 124040

DocumentationDocumentation

Electronic PPCR – Report assessment findings Complete AED usage section

Code summary (LP12).


Special Special

SituationsSituations

Rev. June 08Rev. June 08 4141Teamwork* Integrity* Professionalism* Service*

Special SituationsSpecial Situations

Medication patchesMedication patches Artificial pacemakersArtificial pacemakers Automated internal cardiac Automated internal cardiac

defibrillators (AICDs)defibrillators (AICDs) Traumatic arrestsTraumatic arrests

Rev. Oct 09 Teamwork* Integrity* Professionalism* Service* 42


Medication PatchesMedication Patches

Aluminum backing or Aluminum backing or the medium is the medium is reactive.reactive.

Patch either heats up Patch either heats up or ignites.or ignites.

Expose the patient and Expose the patient and remove remove ALLALL patches patches before defibrillation.before defibrillation.

Wipe any medication Wipe any medication off the chest.off the chest.

Use gloves when you remove it.



Automated Internal Cardiac Automated Internal Cardiac Defibrillator (AICD)Defibrillator (AICD)

In patients with In patients with recurrent recurrent arrhythmias.arrhythmias.

If found on the right If found on the right Do not place the pad Do not place the pad on the AICD.on the AICD.

It’s presence does It’s presence does not preclude not preclude attaching and using attaching and using an AED.an AED.



Artificial PacemakersArtificial Pacemakers

Pulse generator and Pulse generator and wires to the heart.wires to the heart.

Usually found on the Usually found on the left side of the cheat.left side of the cheat.

If found on the right If found on the right Do not place the pad Do not place the pad over the pacemaker.over the pacemaker.

A direct shock to the A direct shock to the pacemaker could pacemaker could cause it to reprogram.cause it to reprogram.



Trauma & Obvious DeathTrauma & Obvious Death AED should not be attached to a patient AED should not be attached to a patient

that is obviously dead.that is obviously dead.

Signs of incompatible with life, e.g., rigor

mortis, etc.

Signs of injuries incompatible with life

AED may be attached to a trauma patient AED may be attached to a trauma patient

in cardiac arrest since the cardiac arrest in cardiac arrest since the cardiac arrest

may have caused the trauma.may have caused the trauma.


Batteries of the AEDBatteries of the AED

Rev. Dec 12Rev. Dec 12 4747Teamwork* Integrity* Professionalism* Service

LP 1000 BatteryLP 1000 Battery The 1000 is powered by a

nonrechargeable lithium manganese dioxide battery pak

Battery pak fuel gauge indicates battery’s charge level

Fully charged battery: all green lights illuminated


LP 1000 BatteryLP 1000 Battery

Low battery: single steady green light

Empty battery: single flashing green light


LP 1000 BatteryLP 1000 Battery The approximate level of charge in the

battery appears on the readiness display when the 1000 is off

Battery low: battery symbol has one bar Battery empty: battery symbol has no bars When low it cannot be replaced on the scene


LP 12 and 15 BatteriesLP 12 and 15 Batteries


The LP 12 and 15 Batteries are powered by lithium ion battery pak and are rechargeable

Battery pak fuel gauge indicates battery’s charge

level

Fully charged battery: all green lights illuminatedCan be replaced when low and will not interrupt the operation of the AED


Troubleshooting and Troubleshooting and

Maintenance Maintenance

of the AEDof the AED

Rev. Dec 12Rev. Dec 12 5252Teamwork* Integrity* Professionalism* Service*

““Connect Electrodes” Connect Electrodes” MessageMessage

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

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


Motion detected, stop Motion detected, stop motion”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

Teamwork* Integrity* Professionalism* Service*Rev. Oct 09 54

““Replace Battery”Replace Battery”

Possible causes: Battery pak 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 SymbolMaintenance Symbol

If the 1000 requires service, the wrench symbol appears

If the wrench is visible, remove the

1000 from service and contact authorized service personnel


MaintenanceMaintenance Daily Auto Test (LP 1000 only)

The 1000 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


MaintenanceMaintenance

Self-test Each time the 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


Routine MaintenanceRoutine Maintenance On a periodic basis check the

following: OK symbol is visible on LP1000 Battery gauge level on LP 12/15 Use-by date on electrode pads has not

passed Other emergency supplies stored with

the unit are present (e.g., face masks, gloves, razors, etc.)

Damage to or foreign substancesTeamwork* Integrity* Professionalism* Service*Dev. Oct 09 59

Recommended Corrective Recommended Corrective ActionsActions

Wrench symbol visible: contact authorized service personnel

Battery symbol visible: replace if low battery indicated

Use-by date passed: replace electrode packet Supplies missing: replenish as needed Damage noted: contact authorized

service personnel Foreign substance visible: clean with damp

sponge or cloth with recommended cleaning agents

Teamwork* Integrity* Professionalism*

Service*Rev. Oct 09 60

After-use CareAfter-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



Review QuestionsReview Questions



Disorganized twitching of Disorganized twitching of the ventricle in which no the ventricle in which no blood goes to the body is blood goes to the body is

called:called:

Ventricular Fibrillation



What age range does the What age range does the Semi-Automated External Semi-Automated External

Defibrillation (AED) Defibrillation (AED) protocol allow the cardiac protocol allow the cardiac

arrest patient to be arrest patient to be treated with an AED?treated with an AED?Patients who appear to be one (1) year of age

or olderTeamwork* Integrity* Professionalism* Service*


Prior to ceasing resuscitation Prior to ceasing resuscitation methods all providers will methods all providers will

contact the appropriate LHC-contact the appropriate LHC-Med Control.Med Control.

What are the two instances What are the two instances

when immediate contact should when immediate contact should be made?be made? • Valid DNR is discovered after CPR has begun

• Injuries/circumstances preclude the safe continuation of CPR efforts



When using the LP 1000, When using the LP 1000, after one shock with the after one shock with the AED, your next step is to AED, your next step is to

__________.__________.

Start CPR/2 minutes of CPR



Before delivering a shock, Before delivering a shock, you must say, “________” you must say, “________” while looking around the while looking around the

patient.patient.I’m clear, your clear, we are all clear…

Shocking now.



When Should the Anterior-When Should the Anterior-Posterior Pad Placement Site Posterior Pad Placement Site

be Utilized?be Utilized?

If the electrodes touch in the sternum-apex

position



The absence of any The absence of any electrical rhythm in the electrical rhythm in the

heart is called ___________.heart is called ___________.

Asystole



As a First Responder, As a First Responder, EMT/AET/I/P in Loudoun EMT/AET/I/P in Loudoun County, you are granted County, you are granted STANDING ORDERS to STANDING ORDERS to

deliver ______ total shocks.deliver ______ total shocks.

3Teamwork* Integrity* Professionalism* Service*


Does Hypothermia, Does Hypothermia, overdose and/or drowning overdose and/or drowning effect how a resuscitation effect how a resuscitation

is performed?is performed?Yes

If may prolong the efforts and should be made identified to Medical Control early in the

resuscitation.



In a witnessed cardiac In a witnessed cardiac arrest if you had a choice arrest if you had a choice between initiating CPR or between initiating CPR or

connecting the AED, which connecting the AED, which should you do first?should you do first?Attach the AED and follow the prompts



Are the pediatric AED Are the pediatric AED electrodes used in a electrodes used in a

Lifepak 1000 the same as Lifepak 1000 the same as those used by a medic those used by a medic operating a Lifepak 12?operating a Lifepak 12?

NoThey are not compatible, and when an ALS provides arrives they will need to

replace the pads from the Lifepak 1000 with their Lifepak 12 pediatric pads



The primary locations for the The primary locations for the placement of the electrodes placement of the electrodes

of the AED on an adult patient of the AED on an adult patient is is

___ and _____.___ and _____.

Apex and Sternum



What is age range to consider What is age range to consider using pediatric pads?using pediatric pads?

Intended for use on children 1 to 8 years of age or up to 25kg

(55lb).



One of three things must One of three things must occur which trigger occur which trigger

contacting Medical Control contacting Medical Control and preparing to transport and preparing to transport the patient connected to the patient connected to

the AED. They are:the AED. They are:3 shocks are given

3 consecutive no-shock advised Return of spontaneous pulse



You are transporting a You are transporting a patient in the ambulance patient in the ambulance

when the patient collapses when the patient collapses into cardiac arrest. What into cardiac arrest. What

do you do?do you do? Stop the ambulance, start CPR,

attach the AED, and initiate rhythm analysis



A patient for whom A patient for whom resuscitative measures resuscitative measures have been terminated have been terminated

should be transported to should be transported to which facility?which facility?

LHC- Cornwall or

LHC –Lansdowne ER If ALS procedures have been performed the ALS-

AIC shall accompany the body to the ER


Rev.. Dec 12Rev.. Dec 12 7979

You arrive to assist a patient You arrive to assist a patient in cardiac arrest who has an in cardiac arrest who has an

Automatic Implanted Automatic Implanted Cardiac Defibrillator (AICD). Cardiac Defibrillator (AICD).

What should you do?What should you do?

Attach AED and proceed as normal attempting to avoid

the AICD..Teamwork* Integrity* Professionalism* Service*


The sternum pad is placed The sternum pad is placed just below the right _____just below the right _____

clavicle



A 25 year old man is found A 25 year old man is found lying in water on the deck of a lying in water on the deck of a

backyard pool. He is backyard pool. He is unresponsive, not breathing, unresponsive, not breathing, and pulseless. CPR is being and pulseless. CPR is being performed as you prepare to performed as you prepare to use an AED. What should be use an AED. What should be

the next steps?the next steps?Remove the patient from the water, wipe the chest dry and then attach the AED pads firmly

to the chest*Remember the provider scene safety, and to assure they are not standing in water nor the

patient lying in a puddle of water.Teamwork* Integrity* Professionalism* Service*


Questions or Comments?Questions or Comments?


rev. dec 121 loudoun county aed program aed aed teamwork* integrity* professionalism* service*

Documents

aed slide

heart muscle

electrical rhythm

ventricular fibrillation

asystole teamwork

electrical current

ventricular fibrillation

normal electrical activity