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Take charge with an automated external defibrillator

Craig, Karen RN, BS

PHOTO GUIDE

Prepare to act quickly when a patient suddenly becomes unresponsive.

Prepare to act quickly when a patient suddenly becomes unresponsive.

WHEN SOMEONE needs resuscitation, an automated external defibrillator (AED) can help save his life. You can use this computerized device to recognize pulseless ventricular tachycardia and ventricular fibrillation and follow its voice and visual prompts to respond.

The AED shown here uses multifunction electrodes (MFEs) to transmit the patient's cardiac rhythm to the machine for interpretation. The MFEs also deliver monophasic shocks, if indicated, at settings of 200, 200, and 360 joules or biphasic shocks at 120, 120, and 200 joules.

The AED device records audio data as an accessory form of documentation. Follow the manufacturer's recommendations and facility protocol to charge the battery and maintain the device.

Helping an unresponsive patient If your patient appears unresponsive, follow the steps shown in these photos.

  • “Shake and shout” to confirm unresponsiveness. Call a code or tell someone to call a code and get the crash cart. Place the patient supine on a hard, dry surface.
  • Figure

    Figure

  • Assess airway, breathing, and circulation (see The ABCs of AED). If breathing and pulse are absent, expose the patient's chest and dry it if necessary. Turn on the AED power.
  • Figure

    Figure

  • Apply the MFEs to the patient's chest in the anterior sternum-apex position as pictured on the package. Place the anterior pad to the right of his upper sternum and the apex pad at the midaxillary line, left of his nipple. If he has excessive chest hair, clip it to ensure adhesion. (For how to handle special circumstances, see What to do when….) Attach the MFE cables to the AED cable (inset).
  • Figure

    Figure

  • Make sure no one touches the patient. Press the “Analyze” button and stay clear while the machine analyzes his cardiac rhythm. (The inset shows what appears on screen.)
  • Figure

    Figure

  • Follow the audible and visual prompts from the AED. If a shock is indicated, stand clear of the patient and make sure everyone else is clear before you push the “Shock” button, as shown.
  • Figure

    Figure

Shock up to three times if advised. After three shocks, or if a shock isn't indicated, check the patient for signs of circulation. Perform CPR for 1 minute if there are no signs of circulation. After 60 seconds, the AED will alert you to reassess for signs of circulation. If absent, press the “Analyze” button.

Document how you found the patient, his ABCs and treatment, application of the AED, whether a shock was indicated (and how many), arrival of the code team, and who assumed the patient's care.

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The ABCs of AED

  • Open the patient's airway. Use a head-tilt/chin-lift unless he has a neck injury—then use the jaw-thrust maneuver.
  • Check breathing. Look for the rise and fall of his chest. Listen and feel for air movement from his nose and mouth. If he isn't breathing, give two slow breaths (using a pocket mask or bag-valve mask if available).
  • Check circulation (coughing, breathing, or moving), including carotid pulse.
  • If the patient doesn't have a pulse, apply the AED or start chest compressions as follows: Place the heel of one hand on the lower half of his sternum and the heel of your other hand over the heel of the first. Give 30 compressions 1½ to 2 inches deep at a rate of about 100 compressions/minute, then administer two breaths. After four cycles of 30:2, reassess your patient's breathing and circulation.
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What to do when…

…you're unsure which size pads to apply: Use pediatric pads on a child age 1 to 8 years, adult pads on anyone over age 8 or weighing more than 55 pounds.

…wetness is present: Remove the patient from puddles, dry his chest, and stay away from wetness when delivering shocks. Water conducts electricity.

…the patient is wearing a medication patch. Remove it if it's in the way of electrode placement and clean excess medication from the skin before applying the MFE pads.

…the patient has an implanted pacemaker or defibrillator or jewelry in a body piercing: Move the defibrillator pad at least 1 inch from the device or the piercing so current can flow straight between the pads.

…chest hair prevents the pads from sticking or the AED repeats “check electrodes”: Press firmly on the pads and quickly rip them off to clean the area, then apply new pads.

…the patient is wearing an underwire bra. Cut the center of the bra and pull the underwire away from the skin to prevent or minimize a burn.

Karen Craig is president of EMS Educational Services, Inc., in Cheltenham, Pa.

Source: Reprinted from Take charge with an automated external defibrillator, Nursing2005, K Craig, November 2005.

The equipment shown is courtesy of Zoll Medical Corp.

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SELECTED REFERENCES

Handbook of Emergency Cardiovascular Care for Healthcare Providers. Dallas, Tex., American Heart Association, 2004.
    Zoll M Series Operator's Guide. Chelmsford, Mass., Zoll Medical Corp., December 2004.
      © 2006 Lippincott Williams & Wilkins, Inc.