Defibrillator Training PUAOPE 010 B- Operate a Semi

Defibrillator Training PUAOPE 010 B- Operate a Semi Automatic Defibrillator in an Emergency 1 Version 2, August 2008 © Life Saving Victoria

Agenda Defibrillator Training Section 1) Ø Leading Causes of Death in Australia. Ø Chain of Survival. Ø CPR review. Section 2) Ø Mechanical and Electrical Action of the Heart. Ø Cardio Rhythm and Arrhythmias Ø Types of SAED Ø The Defibrillation Process Ø Defibrillation Safety Section 3) Ø Assessment 2

Defibrillator Training Cardiac Arrest • In 2006 there were 133, 739 reported deaths in Australia, of which: ‘Ischaemic heart diseases accounted for 22, 983 deaths in Australia. ’ http: //www. aihw. gov. au/cvd/majordiseases/coronary. cfm 3

Defibrillator Training Cardiac Arrest Q) Why is Defibrillation important? A) ‘It make up an important part of the Chain of survival? ’ 4

Defibrillator Training Chain of Survival Early Access ‘Avoids delay in obtaining assistance’ Ø Cause/recognition of Cardiac Arrest Ø Scene Survey Ø Primary Survey Ø Calling for Help Early CPR ‘Buys time’ Ø Extends duration of ventricular fibrillation Ø Keeps vital organs oxygenated delays irreversible brain damage Early Access. . . ‘ 000’ … to get help Early CPR. . . … to buy time 5

Defibrillator Training Chain of Survival Early Defibrillation ‘Increases sudden Cardiac Arrest victim survival chances’ Early Defibrillation. . . Ø Re-establishes normal rhythm in the heart Ø Combined with Early CPR allows victim best survival chance … to restart heart Early Advanced Care (Life Support) ‘Treatment by Medical Personnel/ Paramedics’ Ø Beyond scope of First Responders Ø More effective if previous three links are completed early/effectively Early Advanced Care. . . … to stablize 6

Defibrillator Training Why? 7

Defibrillator Training Chain of Survival CPR Review Activity 8

Defibrillator Training Action Plan ARC Action Plan D anger R esponse A irway B reathing C ompressions D efibrillation Chain of Survival 9

Defibrillator Training Legal Considerations Four main legal considerations relating to first aid: Øduty of care Ønegligence Øconsent Ørecording 10

Defibrillator Training The Heart Actions of the heart Mechanical action: Ø Pumping of the heart. Electrical action: Ø controls the rhythmic beat of the heart. The electrical impulse passing through the heart muscle can be mapped on a graph called an electrocardiogram (ECG) 11

Defibrillator Training Mechanical Action Right Atrium ‘Receives Blood from Body and blood is then pumped into’ Right Ventricle ‘Blood is then Pumps Blood to the Lungs’ Left Atrium ‘Receives Blood from Lungs and pumps blood into Left Ventricle Pumps Blood to the Body 12

Defibrillator Training The Electrocardiogram The Electrical Action of the Heart The normal pathway of electrical impulse through the heart is: SA (Sinoatrial) Node – pacemaker AV (Atrioventricular) Node Normal Heart Rates: Children 70 -120 beats/min Adults 60 -100 beats/min 13

14 Defibrillator Training

15 Defibrillator Training

Defibrillator Training Cardiac Arrest This can occur as a result of, • Lack of oxygen to the heart and brain through drowning or near drowning. • Disruption to the heart’s normal electrical activity due to electrocution. • Mass blood loss resulting in a loss of blood pressure and thus oxygen to the heart muscles. • Heart Attack due to a complete or partial blockage of a Coronary Artery that supplies blood to the heart. For example, an Acute Myocardial Infarction (AMI). http: //www. heartfoundation. org. au/Heart_Information/Adult_Conditions/Heart_Attack. htm 16

Defibrillator Training Why use a SAED? An Semi-Automatic External Defibrillator (SAED) is: ØA portable device ØAble to recognise shockable rhythms in a patient in cardiac arrest ØAble to deliver an electrical shock to revert the heart back to its normal rhythm 17

Non-Shockable Cardiac Rhythms Defibrillator Training Sinus Rhythm: Sinus rhythm is the normal rhythm of a healthy heart SAED will not recommend, nor allow, a shock if normal sinus rhythm is detected Asystole: There is very minimal electrical activity during ventricular asystole, but no contraction of the heart muscle and, consequently, no pulse. CPR is the only treatment, SAED will not recommend a shock if this rhythm is detected 18

Shockable Heart Arrhythmias Defibrillator Training Ventricular tachycardia (VT): (rapid, ineffective) Heart beats so fast that little or no pulse is generated. Life threatening as it inhibits effective distribution of oxygenated blood. Symptoms Ø Very rapid pulse, or no cardiac output. Ø Unconsciousness ØNo Breathing Treatment DRABC- CPR if not breathing. Attach Defibrillator and follow instructions. 19

Shockable Heart Arrhythmias Defibrillator Training Ventricular Tachycardia (VT) 20

Shockable Heart Arrhythmias Defibrillator Training Ventricular fibrillation (VF): (fluttering, quivering) Electrical activity is uncoordinated and chaotic. Ventricles cannot pump blood throughout body resulting in no cardiac output (no pulse). This is life-threatening and results in collapse with cardiac arrest Signs ØLoss of consciousness ØNo breathing, no “signs of life” Treatment ØDRABC ØDefibrillation 21

Shockable Heart Arrhythmias Defibrillator Training Ventricular Fibrillation (VF) 22

Defibrillator Training S. A. E. D How does the defibrillator work? ‘Charge goes from one pad to the other and then returns. ’ 23

Defibrillator Training The Defibrillation Process Indications for use of SAED: The patient is unresponsive The patient is not breathing and has no “signs of life” The first aider has access to the SAED and is trained in the use of SAED (recommended) When connected, the SAED will: 1. Give instructions to the user 2. Analyze patient’s cardiac electrical activity 3. Advise user of action: Ø Deliver Shock or Recommence CPR. *Important- The ARC recommends SAEDs are only to be used on patients over 8 years or 25 kg. 24

Defibrillator Training The Defibrillation Process Positioning of electrode pads Place Sternum electrode pad to the right of the sternum (breastbone) below the collarbone and above the right nipple Place the Apex electrode pad to the left of the sternum, with upper edge of pad below and to the left of the nipple Do not remove electrodes after pulse returns. 25

Defibrillator Training The Defibrillation Process Effective adherence of electrode pads Ø Only place electrode pads on clean, dry skin Ø Do not use alcohol wipes Ø If chest is hairy, remove hair with shears Ø Apply electrode pads with a smooth rolling action to prevent air bubbles Ø Once applied, electrode pads should not be repositioned or removed Ø Do not use electrodes after their expiry date 26

Defibrillation Safety Defibrillator Training Safety Considerations: Ø Remove any metallic jewellery near the electrode sites Ø Make sure pads are at least 10 cm away from an implanted pacemaker Ø Do not place pads over medication patches Ø Avoid contact between electrodes and metal surfaces Ø Do not operate SAED in a moving or explosive environment as this may effect the ECG analysis. Ø Patient should be dry and clear of water. Ø Oxygen approx. 1 m from patient. Ø Use only equipment that is compatible with the unit Ø Do not operate the unit in close proximity to mobile phones, radios etc 27

Defibrillation Safety Defibrillator Training Most Important……. . Do not make contact with patient during shock delivery to prevent harm to rescuer. To help you remember this when unit advises shock say the following out loud. “I’m clear, you’re clear, everybody’s clear” 28

Troubleshooting Defibrillator Training Ø Damaged pads Ø Replace pads Ø Pads not firmly attached Ø Press firmly on pads Ø Cable not correctly plugged in Ø Ensure cable is fully inserted Ø Victim’s chest isn’t dry or is excessively hairy Ø Wipe chest dry or clip hair Ø Analysis interrupted by moving or touching the victim Ø Don’t touch victim, stop movement, restart analysis Ø Interference from radios or mobile phones Ø Keep at least 2 m from AED Ø Battery is low Ø Replace battery If unit is not working, revert back to DRABCD and continue with CPR. 29 Natoli, D. , & Lippmann, J. (2002). Automated External Defibrillators. Melbourne: J. L. Publications

Defibrillator Training SAED kit requirements ØDefibrillator ØSpare battery (if applicable) ØResuscitation masks ØSpace blanket ØGloves ØPen and paper ØShears ØChamois or towel ØGauze wipes (or similar) 30

Defibrillator Training Equipment Maintenance Where should the unit be stored? Ø Usually in a dry stable environment. Refer to user guide. What needs to be done post incident? Ø Equipment check, disposable items replaced. Refer to user guide. Minor Faults and Repair Ø Charge – battery replacement. Ø Electrode pads – date and still sealed. Ø Other minor faults as per manufacturer guidelines. Major fault reporting Ø Recorded in log book Ø Relevant person notified for immediate repair 31

Defibrillator Training Reporting After an incident, it is advised that you report everything you did. Ambulance Officers or Paramedics may also request a report. Under the OH&S Act, reports of all incidences at the workplace should be recorded. 32

Defibrillator Training F. A. Q. • ‘Can you defibrillate a pregnant woman? ’ • ‘Can you defibrillate a wet person? ’ • ‘What if I am not sure they need Defibrillation? ’ 33