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Early Defibrillation and the EMT-Basic

Early Defibrillation and the EMT-Basic. Temple College EMS 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.

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Early Defibrillation and the EMT-Basic

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  1. Early Defibrillation and the EMT-Basic Temple College EMS Professions

  2. Rationale • Most frequent initial rhythm in adult cardiac arrest: ventricular fibrillation

  3. Rationale • Most effective treatment for VF: defibrillation

  4. Rationale • Increased VF time = Decreased survival probability 1 minute of VF = ~10% decrease in chance of survival

  5. Rationale • BLS cannot convert VF to normal sinus rhythm • BLS only increases time available to defibrillate

  6. Principle of Early Defibrillation All personnel who respond to cardiac arrests must be trained to operate, equipped with, and permitted to operate a defibrillator

  7. Automatic External Defibrillators

  8. AED Definition • External defibrillator that incorporates rhythm analysis system

  9. AED Types Fully Automatic Semi- Automatic

  10. Operational Steps • Assess scene, patient • Confirm cardiac arrest • Turn on power • Attach device • Initiate rhythm analysis • Deliver shock if indicated

  11. Standard Procedures • Assess scene for safety • Water • Explosive atmosphere • Patient on conductive surfaces

  12. Standard Procedures Do NOT use AED if patient is: < 8 years old Weighs < 55 pounds

  13. Standard Procedures • Assess patient • ABCs • Presence of transdermal medication patches (nitro patches) • Confirm arrest • Unresponsive • Apneic • Pulseless

  14. Standard Procedures • Start BLS • Attach defibrillator • Do NOT waste time setting up O2, suction, IVs, etc. • Place pads in Lead 2 position

  15. Standard Procedures • Stop CPR, analyze rhythm • Avoid patient contact during analysis • If machine says “shock,” • “Clear” patient • Deliver shock • Immediately reanalyze

  16. 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

  17. 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

  18. Post-Resuscitation Care • Continue to support airway, ventilation • Supplemental O2 • Clear airway if vomiting occurs • Monitor vitals • Stabilize, transport, meet ACLS team

  19. Skill Maintenance • Practice • Drill at least monthly • Rotate responsibility for checking machine

  20. Quality Assurance • Case-by-case review of AED use • Written report • Voice/ECG recording • Code summary tapes

  21. 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

  22. Public Access Defibrillation

  23. Summary Shock Early and Shock Often!

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