Automated External Defibrillation

1. Automated External Defibrillation Dr. Mohamed Hany Moro Director of ER Dept. Dar Al Fouad Hospital ALS - Course Director (ERC) Ministry Advisor for Emergency medicine and Disaster Management

2. Objectives • Recommendations for use of AED • Types of AEDs • AED Algorithm • Special considerations for the use of AED • Use of AED in children • Public access defibrillation • AED in Egypt

3. Chain of Survival

4. Introduction • Approximately 700,000 cardiac arrests per year in Europe. Many victims of sudden cardiac arrest can survive if bystanders act immediately while ventricular fibrillation (VF) is still present; • Survival to hospital discharge presently approximately 5-10% • Bystander CPR vital intervention before arrival of emergency services.

5. Recommendations • The AHA strongly advocates that all EMS first-response vehicles and ambulances be equipped with an AED or another defibrillation device (semiautomatic or manual defibrillator). • The AHA also supports placing AEDs in targeted public areas such as sports arenas, gated communities, office complexes, doctor's offices, shopping malls, etc. • Persons responsible for using the AED are trained in CPR and how to use an AED.

6. European Resuscitation Council (ERC)introduced the AED for the first time in the guidelines released on 2005

7. Electrical defibrillation is well established as the only effective therapy for cardiac arrest caused by VF or pulseless ventricular tachycardia (VT). • The scientific evidence to support early defibrillation is overwhelming; the delay from collapse to delivery of the first shock is the single most important determinant of survival. The chances of successful defibrillation decline at a rate of 7-10% with each minute of delay; basic life support will help to maintain a shockable rhythm but is not a definitive treatment.

8. Types of AEDS • AEDs are sophisticated, reliable, safe, computerized devices that deliver defibrillatory shocks to victims of cardiac arrest. • They use voice and visual prompts to guide rescuers, and are suitable for use by lay rescuers and healthcare professionals. • There are two types of AED: most are semi-automatic, but a few fully-automatic AEDs are available. • All AEDs analyze the victim’s rhythm, determine the need for a shock, and then deliver a shock.

9. A semiautomatic AED advises the need for a shock, but this has to be delivered by the operator when prompted. Some semi-automatic AEDs have the facility to enable the operator (normally a healthcare professional) to override the device and deliver a shock manually, independently of any prompts

11. APPROACH SAFELY! Scene Rescuer Victim Bystanders Approach safely Check response Shout for help Open airway Check breathing Call 123 30 chest compressions 2 rescue breaths

12. CHECK RESPONSE إفحص الوعي Approach safely Check response Shout for help Open airway Check breathing Call 123 30 chest compressions 2 rescue breaths

13. CHECK RESPONSE • Shake shoulders gently هز المريض من الكتف برفق • Ask “Are you all right?” إسال ”هل أنت بخير“ • If he responds إذا إستجاب • Leave as you find him. • دعه كما وجدته • Find out what is wrong. • إبحث عن الأسباب

14. SHOUT FOR HELP Approach safely Check response Shout for help Open airway Check breathing Call 123 30 chest compressions 2 rescue breaths

15. OPEN AIRWAY إفتح الممر الهوائي Approach safely Check response Shout for help Open airway Check breathing Call 123 30 chest compressions 2 rescue breaths

16. CHECK BREATHING إفحص التنفس Approach Safely Check Response Shout of Help Open Airway Check breathing Call 123 30 chest compressions 2 rescue breath

17. Look, listen and feel for NORMAL breathing ” أنظر و إستمع و حس التنفس الطبيعي ” Do not confuse agonal breathing with NORMAL breathing ” لا تخلط بين التنفس الطبيعي و أنفاس الاحتضار“ CHECK BREATHING

18. CALL 123 إتصل برقم 123 Approach safely Check response Shout for help Open airway Check breathing Call 123 30 chest compressions 2 rescue breaths

19. 30 CHEST COMPRESSIONS ٣٠ضغطة على الصدر Approach safely Check response Shout for help Open airway Check breathing Call 123 30 chest compressions 2 rescue breaths

20. CHEST COMPRESSIONS الضغط على الصدر • Place the heel of one hand in the centre of the chest “ • ضع كعب اليد في منتصف الصدر“ • Place other hand on top ” • ضع اليد الأخري فوق الأولي “ • Interlock fingers ”شبك الأصابع“ • Compress the chest ” • إضغط الصدر“

21. CHEST COMPRESSIONS الضغط على الصدر • Rate 100 min-1” • معدل 100 في الدقيقة“ • Depth 4-5 cm “ • عمق 4 – 5 سم“ • When possible change CPR operator every 2 min • إذا امكن غير القائم علي الإنضغط الصدري كل دقيقتين

22. RESCUE BREATHS ۲ أنفاس إنقاذ Approach safely Check response Shout for help Open airway Check breathing Call 123 30 chest compressions 2 rescue breaths

23. Open airway إفتح ممر الهواء Lift chin ”رفع الذقن“ Tilt head“ إمالة الراس“ Pinch the nose“ أغلق الأنف“ Take a normal breath ”خذ نفس طبيعي“ Place lips over mouth ضعشفتاك حول فم المصاب“ Blow until the chest rises ” إنفخ حتي يرتفع صدر المصاب“ Take about 1 second“ استمر حوالي ثانية واحدة“ Allow chest to fall اسمح بخروج الهواء من الصدر RESCUE BREATHS أنفاس إنقاذ

24. CONTINUE CPR 30 2

25. DEFIBRILLATION

26. Approach safely Check response Shout for help Open airway Check breathing Call 123 Attach AED Follow voice prompts

27. SWITCH ON AED Some AEDs will automatically switch themselves on when the lid is opened بعض الأجهزة سوف تعمل تلقائياّ عند فتح الغطاء With others you need to press the "ON"-button ” في باقي الأجهزة تحتاج إلي ان تضغط علي ”إبدأ“ ” إفتح جهاز ازالة الرجفان الألي الخارجي

28. ATTACH PADS TO CASUALTY’S BARE CHEST قم بتوصيل جهاز ازالة الرجفان الألي الخارجي

29. Electrode Pad Placement • Right electrode pad • To the right of the breastbone • Below the collarboneabove the right nipple • Left electrode pad • Outside the left nipple, upper edge of the pad several inches below the left armpit

30. Effective Adherence of Pads • Sweaty chest • Dry with a toweland Don’t use alcohol • جفف الصدر المبلل بواسطة منشفه و لا تستخدم الكحل • Hairy chest • Shaving may be needed • قم باذالة الشعر أذا لزم الامر

31. ANALYSING RHYTHM DO NOT TOUCH VICTIM جاري تحليل النظم – لا تلمس المريض

32. SHOCK INDICATED • Stand clear ابق بعيدا • Deliver shock اعط الصدمة ينصح بإعطاء صدمة

33. SHOCK DELIVEREDFOLLOW AED INSTRUCTIONS بعد اعطاء الصدمة - إتبع التعليمات الصوتية 30 2

34. NO SHOCK ADVISEDFOLLOW AED INSTRUCTIONS لا ينصح بالصدمة - إتبع التعليمات الصوتية 30 2

35. IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN RECOVERY POSITION إذا بدأ المريض بالتنفس – ضع المريض في وضع الإفاقة

36. Special Considerations • Is victim lying in water? • Is victim wearing a transdermal medication patch on his or her chest? • Does victim have a pacemaker or implanted defibrillator? • Is victim less than 8 years old?

37. AED IN CHILDREN • Age > 8 years • use adult AED • Age 1-8 years • use paediatric pads / settings if available (otherwise use adult mode) • Age < 1 year • use only if manufacturer instructions indicate it is safe

38. Public access defibrillation (PAD) • Public access defibrillation (PAD) and first-responder programmers are now widespread. An important factor contributing to the high success rates of PAD is the short response time from collapse to resuscitation. • Some ambulance have reduced the time to defibrillation by using trained, lay, responders. Although such a strategy has been reported to improve the incidence of return of spontaneous circulation and survival to hospital admission, there is as yet limited evidence of increased survival to hospital discharge.

39. AED in Egypt • AEDs should be deployed within a medically-controlled system under the direction of a medical adviser. This may be a doctor from any medical discipline who has clinical expertise in resuscitation. • The ‘medical director/adviser’ is responsible for ensuring that controls are in place to ensure adequate training of AED users, with periodic refresher training.

40. This training and retraining must be provided by appropriately qualified individuals, for example resuscitation training officers, community defibrillation officers, medical or nursing staff, ambulance service trainers, and other individuals such as first aid trainers accredited in AED training. • Basic life support skills must also be taught, assessed, and refreshed inaccordance with current guidelines.

41. To have the greatest impact, such schemes should be introduced where the risk of cardiac arrest is highest. • It has been suggested that for public access schemes to be cost effective, the probability of cardiac arrest occurring in the location should be at least once every two years.

46. Thank you