The Defibrillation Process - Life Saving Victoria
The Defibrillation Process - Life Saving Victoria
The Defibrillation Process - Life Saving Victoria
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DEFIBRILLATION<br />
PUAOPE010A Operate a semi automatic defibrillator in an emergency<br />
Chapter 24 – <strong>Defibrillation</strong><br />
© Surf <strong>Life</strong> <strong>Saving</strong> Australia – Version 2<br />
SLSA Defibrillator Course / PUAOPE010A Operate a semi automatic defibrillator in an emergency 24.1
UNIT 24 –<br />
DEFIBRILLATION<br />
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<strong>Defibrillation</strong><br />
What is <strong>Defibrillation</strong>? (pg 173)<br />
What is an SAED? (pg 173)<br />
Chain of Survival (pg 173)<br />
<strong>The</strong> Electro-cardiogram (pg 174)<br />
Cardio Rhythm and Arrhythmias (pg 174)<br />
Types of SAED (pg 175)<br />
<strong>The</strong> <strong>Defibrillation</strong> <strong>Process</strong> (pg 175)<br />
<strong>Defibrillation</strong> Safety (pg 177)<br />
(Page numbers relate to the Surf <strong>Life</strong> <strong>Saving</strong><br />
First Aid and Emergency Care Manual)<br />
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SLSA Defibrillator Course / PUAOPE010A Operate a semi automatic defibrillator in an emergency 24.3
<strong>Defibrillation</strong><br />
Chance of Survival<br />
%<br />
100<br />
90<br />
80<br />
70<br />
60<br />
50<br />
40<br />
30<br />
20<br />
10<br />
0<br />
Sudden cardiac arrest is one of the leading<br />
causes of death in Australia<br />
Survival rates decline dramatically with each<br />
minute that passes without defibrillation<br />
1 2 3 4 5 6 7 8 9 10<br />
Time Elapsed in Minutes<br />
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SLSA Defibrillator Course / PUAOPE010A Operate a semi automatic defibrillator in an emergency 24.4
What is <strong>Defibrillation</strong>?<br />
Ventricular fibrillation (VF) is the rapid, irregular<br />
and uncoordinated contraction of the heart<br />
<strong>Defibrillation</strong> involves delivering an electric shock<br />
to revert the heart to its normal rhythm<br />
Heart attack is a common cause of VF<br />
• Heart ceases to function effectively<br />
• Can cause permanent damage or death<br />
• <strong>Defibrillation</strong> is most effective method to reverse VF<br />
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What is an SAED?<br />
An Semi-automatic external defibrillator (SAED) is:<br />
• A portable device<br />
• Able to recognise shockable rhythms in a patient in<br />
cardiac arrest<br />
• Able to deliver an electrical shock to revert the heart back<br />
to its normal rhythm<br />
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SLSA Defibrillator Course / PUAOPE010A Operate a semi automatic defibrillator in an emergency 24.6
Chain of Survival<br />
Early<br />
Access<br />
Early<br />
CPR<br />
Early<br />
<strong>Defibrillation</strong><br />
Early<br />
Advanced<br />
Care<br />
To get<br />
Help<br />
To buy<br />
time<br />
To restart<br />
Heart<br />
To<br />
stabilise<br />
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Chain of Survival<br />
Early Access<br />
‘Avoids delay in obtaining assistance’<br />
• Cause/recognition of Cardiac Arrest<br />
• Scene Survey<br />
• Primary Survey<br />
• Calling for Help<br />
• Secondary Survey<br />
Early Access ...<br />
‘000’<br />
… to get help<br />
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Chain of Survival<br />
Early CPR<br />
‘Buys time’<br />
• Extends duration of ventricular defibrillation<br />
• Keeps vital organs<br />
oxygenated<br />
• Delays irreversible<br />
brain damage<br />
Early CPR ...<br />
… to buy time<br />
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SLSA Defibrillator Course / PUAOPE010A Operate a semi automatic defibrillator in an emergency 24.9
Chain of Survival<br />
Early <strong>Defibrillation</strong><br />
‘Increases sudden Cardiac Arrest victim<br />
survival chances’<br />
• Re-establishes normal<br />
rhythm in the heart<br />
• Combined with Early<br />
CPR allows victim best<br />
survival chance<br />
Early <strong>Defibrillation</strong> ...<br />
… to restart heart<br />
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Chain of Survival<br />
Early Advanced Care (<strong>Life</strong> Support)<br />
‘Treatment by Medical Personnel/Paramedics’<br />
• Beyond scope of<br />
First Responders<br />
• More effective if<br />
previous three links<br />
are completed<br />
early/effectively<br />
Early Advanced Care ...<br />
… to stablize<br />
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<strong>The</strong> Electrocardiogram<br />
Actions of the heart<br />
1) Mechanical action:<br />
the pumping of the heart<br />
2) Electrical action:<br />
controls the rhythmic beat of the heart<br />
<strong>The</strong> electrical impulse passing through the<br />
heart muscle can be mapped on a graph<br />
called an electrocardiogram (ECG)<br />
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<strong>The</strong> Electrocardiogram<br />
Revision: Heart Mechanical Action<br />
Right Atrium - Receives Blood from Body<br />
pumped into: -<br />
Right Ventricle - Pumps Blood to the Lungs<br />
Left Atrium - Receives Blood from Lungs<br />
pumped into: -<br />
Left Ventricle - Pumps Blood to the Body<br />
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<strong>The</strong> Electrocardiogram<br />
<strong>The</strong> Electrical Action of the Heart<br />
<strong>The</strong> normal pathway of electrical impulse<br />
through the heart is:<br />
• SA (Sinoatrial) Node – pacemaker<br />
• AV (Atrioventricular) Node<br />
– Electrical gateway between atria and ventricles<br />
• Right and Left Bundles/Purkinjie fibres<br />
– Distribution network of electrical impulse<br />
to both ventricles<br />
Normal Heart Rates:<br />
Infants/newborn 100-160 beats/min<br />
Children 70-120 beats/min<br />
Adults 60-100 beats/min<br />
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Cardiac Rhythm & Arrhythmias<br />
SAEDs designed to<br />
detect life<br />
threatening<br />
arrhythmias:<br />
• VF - recommend<br />
defibrillation<br />
No need to identify<br />
differing rhythms<br />
Following slides for<br />
information only<br />
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Cardiac Rhythm & Arrhythmias<br />
Sinus Rhythm:<br />
• Sinus rhythm is the normal rhythm of a healthy heart<br />
• SAED will not recommend, nor allow, a shock if normal<br />
sinus rhythm is detected<br />
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Cardiac Rhythm & Arrhythmias<br />
Ventricular tachycardia (VT):<br />
• Ventricular tachycardia (VT) occurs when the<br />
ventricles beat faster than the rhythm generated<br />
by the sinoatrial node<br />
• May be life threatening as it may inhibit effective<br />
distribution of oxygenated blood<br />
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Cardiac Rhythm & Arrhythmias<br />
Ventricular tachycardia (VT):<br />
Symptoms<br />
• Very rapid pulse, or no pulse<br />
• Palpitations – heart racing<br />
• Light-headedness or dizziness<br />
• Angina or chest pain<br />
Signs<br />
• Fainting<br />
• Difficulty breathing<br />
Treatment<br />
• If VT progresses to a pulseless VT,<br />
>180 beats/min, SAED will recommend a shock<br />
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Cardiac Rhythm & Arrhythmias<br />
Ventricular fibrillation (VF):<br />
• Ventricular fibrillation (VF) is characterised by disordered<br />
electrical activity and unsynchronised, very rapid<br />
ventricular fluttering<br />
• Ventricles cannot pump blood throughout body resulting<br />
in no cardiac output and no pulse<br />
• This is life-threatening and results in collapse with<br />
cardiac arrest<br />
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Cardiac Rhythm & Arrhythmias<br />
Ventricular fibrillation (VF):<br />
Signs<br />
• Loss of consciousness<br />
• No breathing, no “signs of life”<br />
Treatment<br />
• DRABC<br />
• <strong>Defibrillation</strong><br />
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Cardiac Rhythm & Arrhythmias<br />
Asystole:<br />
• <strong>The</strong>re is very minimal electrical<br />
activity during ventricular asystole,<br />
but no contraction of the heart<br />
muscle and, consequently, no pulse<br />
• CPR is the only treatment<br />
• SAED will not recommend a shock<br />
if this rhythm is detected<br />
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Types of SAED<br />
Monophasic:<br />
• <strong>The</strong> electric current is<br />
triggered and passes<br />
only from one pad to<br />
the other<br />
• <strong>The</strong>y deliver a preset<br />
charge of 200kJ on the<br />
first and second shocks,<br />
and then a 360 kJ for<br />
the third and subsequent<br />
shocks<br />
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Types of SAED<br />
Biphasic:<br />
• <strong>The</strong> charge goes from one pad to the other and then returns<br />
• It is possible to run them at a lower voltage.<br />
• <strong>The</strong> usual charge can be less than the monophasic models,<br />
but just as effective (Laerdal FR2 – 150 kJ)<br />
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<strong>The</strong> <strong>Defibrillation</strong> <strong>Process</strong><br />
<strong>The</strong> SAED:<br />
• Delivers an electric<br />
shock through<br />
electrodes<br />
• This STOPS the<br />
heart’s abnormal<br />
activity<br />
• Restoring normal<br />
sinus rhythm<br />
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<strong>The</strong> <strong>Defibrillation</strong> <strong>Process</strong><br />
Indications for use of SAED:<br />
• <strong>The</strong> patient is unresponsive<br />
• <strong>The</strong> patient is not breathing<br />
• <strong>The</strong> patient has no “signs of life”<br />
• <strong>The</strong> first aider has access to the SAED<br />
• <strong>The</strong> first aider is trained/certified in the use of SAED<br />
• SLSA Policy :<br />
Only to be used on patients<br />
over 8 years or 40kg<br />
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<strong>The</strong> <strong>Defibrillation</strong> <strong>Process</strong><br />
When connected the SAED will:<br />
• Prompt specific actions<br />
• Analyse patient’s ECG<br />
• Advise:<br />
– Shock (if appropriate rhythm)<br />
– Or recommence CPR<br />
• Deliver shock when activated by operator<br />
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<strong>The</strong> <strong>Defibrillation</strong> <strong>Process</strong><br />
Operation of the SAED<br />
Confirm patient in need:<br />
• Unresponsive, No breathing, No “signs of life”<br />
Safe Conditions:<br />
• No Water, No Metal<br />
• No pacemaker/patches<br />
• Oxygen approx. 1m from patient<br />
• No one touching patient<br />
• Turn on defibrillator<br />
• Respond to prompts<br />
• Deliver shock<br />
• Maintain Basic <strong>Life</strong> Support protocols<br />
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<strong>The</strong> <strong>Defibrillation</strong> <strong>Process</strong><br />
Effective adherence of electrode pads<br />
• Only place electrode pads on clean, dry skin<br />
• Do not use alcohol wipes<br />
• If chest is hairy, remove hair with razor or shears<br />
• Apply electrode pads with a<br />
smooth rolling action to<br />
prevent air bubbles<br />
• Once applied, electrode<br />
pads should not be<br />
repositioned or removed<br />
• Do not use electrodes after<br />
their expiry date<br />
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<strong>The</strong> <strong>Defibrillation</strong> <strong>Process</strong><br />
Positioning of electrode pads<br />
• Place sternum electrode pad to the<br />
right of the sternum (breastbone)<br />
below the collarbone and above<br />
the right nipple<br />
• Place the apex electrode pad to the left<br />
of the sternum, with upper edge of pad<br />
below and to the left of the nipple<br />
Do not remove electrodes after<br />
pulse return<br />
Do not place over patches<br />
At least 10cm from pacemaker<br />
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<strong>The</strong> <strong>Defibrillation</strong> <strong>Process</strong><br />
Accessories:<br />
• Resuscitation masks<br />
• Gloves<br />
• Razors<br />
• Shears<br />
• Gauze wipes (or similar)<br />
• Spare battery (if applicable)<br />
• Space blanket<br />
• Pen and paper<br />
• Chamois or towel<br />
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<strong>The</strong> <strong>Defibrillation</strong> <strong>Process</strong><br />
Shock Delivery Protocols<br />
Depending on age and type of SAED, there may<br />
be various Protocols:<br />
• One shock, or<br />
• Three shock clusters<br />
Varying shock output:<br />
• Biphasic or Monophasic<br />
• 150kJ, 200kJ or 360kJ<br />
Follow the prompts of<br />
the SAED you have<br />
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<strong>The</strong> <strong>Defibrillation</strong> <strong>Process</strong><br />
Shock Delivery Protocols<br />
One Shock Delivery<br />
As soon as machine is available:<br />
• Cease CPR<br />
• Deliver one shock<br />
• Check for signs of life<br />
Follow prompts:<br />
• 2 minutes CPR or Lateral position<br />
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<strong>The</strong> <strong>Defibrillation</strong> <strong>Process</strong><br />
Shock Delivery Protocols<br />
Three Shock Delivery:<br />
As soon as machine is available:<br />
Follow prompts:<br />
• Usually three shocks in a “cluster”<br />
• followed by a minute of CPR<br />
• followed by three more shocks, etc<br />
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<strong>Defibrillation</strong> Safety<br />
Safety Considerations:<br />
• Operator must be trained/certified in the use of the<br />
defibrillator<br />
• Patient must be unresponsive - not breathing,<br />
no “signs of life”<br />
• Remove any metallic jewellery near the electrode sites<br />
• Do not place electrodes over medication patches<br />
• Avoid contact between electrodes and metal surfaces<br />
• No contact with patient during shock delivery<br />
– “I’m clear, you’re clear, everybody’s clear”<br />
• Do not operate SAED in an explosive environment<br />
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<strong>Defibrillation</strong> Safety<br />
Safety Considerations continued…<br />
• In wet conditions wipe chest dry before positioning<br />
electrodes<br />
• Make sure pads are at least 10cm away from an<br />
implanted pacemaker<br />
• Use only equipment that is compatible with the unit<br />
• Do not operate the unit in close proximity to mobile<br />
phones, radios etc<br />
• Do not operate the unit in an unstable environment<br />
which may prevent valid assessment of ECG signal<br />
• Be aware of an incoming tide (if applicable)<br />
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Equipment Maintenance<br />
SLSA <strong>Defibrillation</strong> Policy and Procedure<br />
• Refer to SLSA Policy<br />
• Storage and pre-patrol and post checks<br />
Minor Faults and Repair<br />
• Charge – battery replacement<br />
• Electrode pads – date and still sealed<br />
• Other minor faults as per manufacturer guidelines<br />
Major fault reporting<br />
• Patrol Captain notified<br />
• Recorded in patrol log<br />
• Club official notified for immediate repair<br />
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Thank You<br />
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