DEFIBRILLATION PUAOPE010A Operate a semi automatic defibrillator in an emergency
Chapter 24 – Defibrillation
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UNIT 24 – DEFIBRILLATION
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Defibrillation What is Defibrillation? What is an SAED? Chain of Survival The Electro-cardiogram Cardio Rhythm and Arrhythmias Types of SAED The Defibrillation Process Defibrillation Safety
(pg 173) (pg 173) (pg 173) (pg 174) (pg 174) (pg 175) (pg 175) (pg 177)
(Page numbers relate to the Surf Life Saving First Aid and Emergency Care Manual)
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Defibrillation Sudden cardiac arrest is one of the leading causes of death in Australia
% 100
Survival rates decline dramatically with each minute that passes without defibrillation
Chance of Survival
90 80 70 60 50 40 30 20 10 0 1
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Time Elapsed in Minutes © Surf Life Saving Australia – Version 2
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What is Defibrillation? Ventricular fibrillation (VF) is the rapid, irregular and uncoordinated contraction of the heart Defibrillation involves delivering an electric shock to revert the heart to its normal rhythm Heart attack is a common cause of VF • Heart ceases to function effectively • Can cause permanent damage or death • Defibrillation is most effective method to reverse VF
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What is an SAED? An Semi-automatic external defibrillator (SAED) is: • A portable device • Able to recognise shockable rhythms in a patient in cardiac arrest • Able to deliver an electrical shock to revert the heart back to its normal rhythm
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Chain of Survival
Early Access
Early CPR
Early Defibrillation
Early Advanced Care
To get Help
To buy time
To restart Heart
To stabilise
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Chain of Survival Early Access ‘Avoids delay in obtaining assistance’ • • • • •
Cause/recognition of Cardiac Arrest Scene Survey Early Access ... Primary Survey Calling for Help ‘000’ Secondary Survey
… to get help
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Chain of Survival Early CPR ‘Buys time’ • Extends duration of ventricular defibrillation • Keeps vital organs Early CPR ... oxygenated • Delays irreversible brain damage
… to buy time
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Chain of Survival Early Defibrillation ‘Increases sudden Cardiac Arrest victim survival chances’ • Re-establishes normal rhythm in the heart • Combined with Early CPR allows victim best survival chance
Early Defibrillation ...
… to restart heart
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Chain of Survival Early Advanced Care (Life Support) ‘Treatment by Medical Personnel/Paramedics’ • Beyond scope of First Responders • More effective if previous three links are completed early/effectively
Early Advanced Care ...
… to stablize
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The Electrocardiogram Actions of the heart 1) Mechanical action: the pumping of the heart
2) Electrical action: 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)
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The Electrocardiogram Revision: Heart Mechanical Action Right Atrium - Receives Blood from Body pumped into: -
Right Ventricle - Pumps Blood to the Lungs Left Atrium - Receives Blood from Lungs pumped into: -
Left Ventricle - Pumps Blood to the Body © Surf Life Saving Australia – Version 2
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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 – Electrical gateway between atria and ventricles
• Right and Left Bundles/Purkinjie fibres – Distribution network of electrical impulse to both ventricles Normal Heart Rates: Infants/newborn 100-160 beats/min Children 70-120 beats/min Adults 60-100 beats/min © Surf Life Saving Australia – Version 2
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Cardiac Rhythm & Arrhythmias SAEDs designed to detect life threatening arrhythmias: • VF - recommend defibrillation
No need to identify differing rhythms Following slides for information only © Surf Life Saving Australia – Version 2
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Cardiac Rhythm & Arrhythmias 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
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Cardiac Rhythm & Arrhythmias Ventricular tachycardia (VT): • Ventricular tachycardia (VT) occurs when the ventricles beat faster than the rhythm generated by the sinoatrial node • May be life threatening as it may inhibit effective distribution of oxygenated blood
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Cardiac Rhythm & Arrhythmias Ventricular tachycardia (VT): Symptoms • • • •
Very rapid pulse, or no pulse Palpitations – heart racing Light-headedness or dizziness Angina or chest pain
Signs •
•
Fainting Difficulty breathing
Treatment • If VT progresses to a pulseless VT, >180 beats/min, SAED will recommend a shock © Surf Life Saving Australia – Version 2
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Cardiac Rhythm & Arrhythmias Ventricular fibrillation (VF): • Ventricular fibrillation (VF) is characterised by disordered electrical activity and unsynchronised, very rapid ventricular fluttering • Ventricles cannot pump blood throughout body resulting in no cardiac output and no pulse • This is life-threatening and results in collapse with cardiac arrest
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Cardiac Rhythm & Arrhythmias Ventricular fibrillation (VF): Signs • Loss of consciousness • No breathing, no “signs of life”
Treatment • DRABC • Defibrillation
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Cardiac Rhythm & Arrhythmias 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
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Types of SAED Monophasic: • The electric current is triggered and passes only from one pad to the other • They deliver a preset charge of 200kJ on the first and second shocks, and then a 360 kJ for the third and subsequent shocks
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Types of SAED Biphasic: • The charge goes from one pad to the other and then returns • It is possible to run them at a lower voltage. • The usual charge can be less than the monophasic models, but just as effective (Laerdal FR2 – 150 kJ)
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The Defibrillation Process The SAED: • Delivers an electric shock through electrodes • This STOPS the heart’s abnormal activity • Restoring normal sinus rhythm
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The Defibrillation Process Indications for use of SAED: • • • • • •
The patient is unresponsive The patient is not breathing The patient has no “signs of life” The first aider has access to the SAED The first aider is trained/certified in the use of SAED SLSA Policy : Only to be used on patients over 8 years or 40kg
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The Defibrillation Process When connected the SAED will: • Prompt specific actions • Analyse patient’s ECG • Advise: – Shock (if appropriate rhythm) – Or recommence CPR • Deliver shock when activated by operator
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The Defibrillation Process Operation of the SAED Confirm patient in need: • Unresponsive, No breathing, No “signs of life”
Safe Conditions: • • • • • • • •
No Water, No Metal No pacemaker/patches Oxygen approx. 1m from patient No one touching patient Turn on defibrillator Respond to prompts Deliver shock Maintain Basic Life Support protocols
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The Defibrillation Process Effective adherence of electrode pads • • • •
Only place electrode pads on clean, dry skin Do not use alcohol wipes If chest is hairy, remove hair with razor or shears Apply electrode pads with a smooth rolling action to prevent air bubbles • Once applied, electrode pads should not be repositioned or removed • Do not use electrodes after their expiry date © Surf Life Saving Australia – Version 2
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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 return Do not place over patches At least 10cm from pacemaker © Surf Life Saving Australia – Version 2
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The Defibrillation Process Accessories: • • • • • • • • •
Resuscitation masks Gloves Razors Shears Gauze wipes (or similar) Spare battery (if applicable) Space blanket Pen and paper Chamois or towel
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The Defibrillation Process Shock Delivery Protocols Depending on age and type of SAED, there may be various Protocols: • One shock, or • Three shock clusters
Varying shock output: • Biphasic or Monophasic • 150kJ, 200kJ or 360kJ Follow the prompts of the SAED you have © Surf Life Saving Australia – Version 2
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The Defibrillation Process Shock Delivery Protocols One Shock Delivery As soon as machine is available: • Cease CPR • Deliver one shock • Check for signs of life Follow prompts: • 2 minutes CPR or Lateral position
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The Defibrillation Process Shock Delivery Protocols Three Shock Delivery: As soon as machine is available: Follow prompts: • Usually three shocks in a “cluster” • followed by a minute of CPR • followed by three more shocks, etc
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Defibrillation Safety Safety Considerations: • Operator must be trained/certified in the use of the defibrillator • Patient must be unresponsive - not breathing, no “signs of life” • Remove any metallic jewellery near the electrode sites • Do not place electrodes over medication patches • Avoid contact between electrodes and metal surfaces • No contact with patient during shock delivery – “I’m clear, you’re clear, everybody’s clear” • Do not operate SAED in an explosive environment
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Defibrillation Safety Safety Considerations continued… • In wet conditions wipe chest dry before positioning electrodes • Make sure pads are at least 10cm away from an implanted pacemaker • Use only equipment that is compatible with the unit • Do not operate the unit in close proximity to mobile phones, radios etc • Do not operate the unit in an unstable environment which may prevent valid assessment of ECG signal • Be aware of an incoming tide (if applicable)
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Equipment Maintenance SLSA Defibrillation Policy and Procedure • Refer to SLSA Policy • Storage and pre-patrol and post checks
Minor Faults and Repair • Charge – battery replacement • Electrode pads – date and still sealed • Other minor faults as per manufacturer guidelines
Major fault reporting • Patrol Captain notified • Recorded in patrol log • Club official notified for immediate repair © Surf Life Saving Australia – Version 2
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Thank You
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