Automated External Defibrillation

Dr. Mohamed Hany MoroDirector of ER Dept. Dar Al Fouad Hospital

ALS - Course Director (ERC)

Ministry Advisor for Emergency medicine and Disaster Management

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

Chain of Survival

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.

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.

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

• 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.

• 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.

Types of AEDS

• 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

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

CHECK RESPONSE

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

إفحص الوعي

Shake shoulders gently الكتف من المريض هزبرفق

Ask “Are you all right?” بخير ” أنت هل “إسال

If he responds إذا إستجاب

• Leave as you find him.

وجدته كما دعه

• Find out what is wrong.

األسباب عن إبحث

CHECK RESPONSE

SHOUT FOR HELP

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

OPEN AIRWAY

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

الممر إفتحالهوائي

CHECK BREATHING

إفحص Approach Safelyالتنفس

Check Response

Shout of Help

Open Airway

Check breathing

Call 123

2 rescue breath

30 chest compressions

CHECK BREATHING

• Look, listen and feel for NORMAL breathing ”

إستمع • و حس أنظر والطبيعي ” التنفس

• Do not confuse agonal breathing with NORMAL breathing ”

التنفس • بين تخلط الالطبيعي

االحتضار أنفاس “و

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

CALL 123برقم إتصل

123

30 CHEST COMPRESSIONS

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

على ٣٠ ضغطةالصدر

CHEST COMPRESSIONS

• Place the heel of one hand in the centre of the chest “

الصدر منتصف في اليد كعب “ضع

• Place other hand on top ”

األولي فوق األخري اليد “ ضع

• Interlock fingers ” األصابع “شبك

• Compress the chest ”

الصدر “إضغط

على الضغطالصدر

– Rate 100 min-1 ”

“100معدل – الدقيقة في– Depth 4-5 cm “

“5 – 4عمق – سم

• When possible change CPR operator every 2 min

علي • القائم غير امكن إذاكل الصدري اإلنضغط

دقيقتين

CHEST COMPRESSIONS

على الضغطالصدر

RESCUE BREATHS

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

أنفاس ۲إنقاذ

RESCUE BREATHS

• Open airway الهواء ممر إفتح– Lift chin ” الذقن “رفع– Tilt head“ الراس “إمالة

• Pinch the nose“ األنف “أغلق• Take a normal breath

•“ طبيعي” نفس خذ• Place lips over mouth

“ ضع• المصاب فم حول شفتاك• Blow until the chest rises ”

المصاب صدر يرتفع حتي “إنفخ• Take about 1 second“

واحدة ثانية حوالي “استمر• Allow chest to fall

من • الهواء بخروج اسمحالصدر

إنقاذ أنفاس

CONTINUE CPR

30 2

DEFIBRILLATION

Call 123

Approach safely

Check response

Shout for help

Open airway

Check breathing

Attach AED

Follow voice prompts

SWITCH ON AED

• Some AEDs will automatically switch themselves on when the lid is opened

تعمل • سوف األجهزة بعضالغطاء فتح عند V تلقائيا

• With others you need to press the "ON"-button ”

تحتاج • األجهزة باقي في” “ إبدأ ” علي تضغط ان إلي

الرجفان ازالة جهاز إفتحالخارجي األلي

ATTACH PADS TO CASUALTY’S BARE CHEST

جهاز بتوصيل قمالرجفان ازالة

الخارجي األلي

• Right electrode padRight electrode pad– To the right of the To the right of the

breastbonebreastbone– Below the collarboneBelow the collarbone

above the right nippleabove the right nipple

• Left electrode padLeft electrode pad– Outside the left nipple, Outside the left nipple,

upper edge of the pad upper edge of the pad several inches below several inches below the left armpitthe left armpit

Electrode Pad PlacementElectrode Pad Placement

Effective Adherence of PadsEffective Adherence of Pads

• Sweaty chestSweaty chest– Dry with a towelDry with a towel and Don’t use and Don’t use

alcoholalcohol

بواسطة • المبلل الصدر بواسطة جفف المبلل الصدر جففالكحل تستخدم ال و الكحل منشفه تستخدم ال و منشفه

• Hairy chestHairy chest– Shaving may be neededShaving may be needed

االمر – لزم أذا الشعر باذالة االمر قم لزم أذا الشعر باذالة قم

ANALYSING RHYTHM DO NOT TOUCH VICTIM

ال – النظم تحليل جاري

المريض تلمس

SHOCK INDICATED

• Stand clear

بعيدا ابق• Deliver shock

الصدمة اعط

صدمة بإعطاء ينصح

SHOCK DELIVEREDFOLLOW AED INSTRUCTIONS

30 2

إتبع - الصدمة اعطاء بعدالصوتية التعليمات

NO SHOCK ADVISEDFOLLOW AED INSTRUCTIONS

30 2

التعليمات - إتبع بالصدمة ينصح الالصوتية

IF VICTIM STARTS TO BREATHE NORMALLY PLACE

IN RECOVERY POSITION

المريضفي – ضع بالتنفس المريض بدأ إذااإلفاقة وضع

Special ConsiderationsSpecial Considerations

• Is victim lying in water?Is victim lying in water?• Is victim wearing a Is victim wearing a

transdermal medication patch transdermal medication patch on his or her chest?on his or her chest?

• Does victim have a Does victim have a pacemaker or implanted pacemaker or implanted defibrillator?defibrillator?

• Is victim less than 8 years old? Is victim less than 8 years old?

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

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.

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.

• 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.

• 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.