Case 2: A.E.D.
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Algorithms

Rhythms

Schedule

Pretest
*Person Collapses (Adult, assume cardiac arrest)
*Check Responsiveness and Breathing - simultaneously (Tap and Shout)  "Are you okay?" - If unresponsive or if pt is not breathing or is agonally breathing, then
*Call emergency response system (call 911 or if in a medical setting call a code blue or retrieve a
  defibrillator/AED if available) - the main rhythm associated with cardiac arrest in an adult is V.fib or
  Pulseless V. Tach and NEEDS to be shocked as soon as possible to survive.

Begin BLS:
C-CIRCULATION (3 steps):
1.Check responsiveness and for breathing Tap and shout, "Are you okay?”
          – look for chest rise – if no response or breathing or
          abnormal breathing go to next step
2.Call a Code Blue if in hospital or if out of hospital Call 9-1-1
3.a. Check Circulation- by palpating a carotid/femoral pulse (within 10
              seconds). If no definite pulse within 10 seconds then, begin chest
              compressions. If a definite pulse is felt, then give 1 breath every 5-6
              seconds. Recheck pulse every 2 minutes or 5 cycles. 
          b. Provide - CIRCULATION w/chest compressions and ventilations
              (30:2) for at least 100-120 compressions per minute, “hard and fast”, at
              least 2 inches deep with minimal interruptions. Allow for complete
              recoil of the chest after each compression.

A-AIRWAY:  Open the AIRWAY using head-tilt-chin lift, if trauma suspected, then use jaw thrust method. Even if trauma suspected and you are the only rescuer available, then open the airway using head-tilt-chin lift.

B- BREATHING: Assessment of this was done in step one - Provide BREATHING (2 breaths) allowing the chest to rise each time, give each breath over 1 second. Avoid excessive ventilations. If the breath does not go in, reposition the head by head-tilt-chin lift and attempt to deliver 2 breaths. Utilizing a bag-valve-mask (BVM) requires a good seal – E-C method, E with 3 fingers along jawbone and C with thumb and forefinger on the mask. Please note that this is best done with 2 rescuerers and not recommended for the single lone rescuer.

Helps arrives and begins D for defibrillation, or if patient has a definite pulse then begin rescue breathing.

Automated External Defibrillator (AED) is available. (Now is not the time to learn to use your AED, so make sure your familiar with the equipment and trouble shooting common problems).

D=Defibrillation:  Follow directions from the AED. 

Quick steps:
Turn on 
Attach electrodes to the patient and machine
Clear to Analyze
Clear to Shock
The voltage recommended - 360 Joules for a monophasic defibrillator.
Most newer defibrillators are biphasic and are recommended for
120 to 200 Joules. Follow manufacturer's guidelines.

1.POWER ON the AED (voice prompting will guide 
         in all other steps)
2.ATTACH the electrode pads to the patient
         a.     Can now be used on infants through adults
         b.     Use adult pads for everyone 8 years and above
         c.     Use child pads and for children 0-8 years old
         d.     Can use adult pads and voltage on all patients if pediatric 
                  patches/voltage is not available.
         e.     Peel the backing away from the electrode pads
         f.      If the patient’s chest is hairy, the pads may not stick
         g.     If the patient is wet, make sure you dry the chest area
         h.     Avoid medication patches and implanted devices – but don’t 
                   delay attaching electrodes for this reason.
3.ATTACH the connecting cables to the AED box, some may be 
          preconnected
4.Clear the patient and allow the AED to ANALYZE the rhythm
         a.Do not touch the patient or allow anyone else to touch the patient
         b.You may need to push a button or it may be automatic after a
                  verbal prompt
5.SHOCK ADVISED or NO SHOCK ADVISED will be indicated
         a.If a shock is advised, then the AED will charge
         b.      Resume chest compressions until the AED is fully charged
         c.Clear the patient:  “I’m clear, you’re clear, everyone’s clear!”
         d.Push the SHOCK button
         e.If no shock advised, skip directly to number 6.
6.Resume CPR beginning with chest compressions
         a.Do not remove the pads
         b.Do not shut off the AED
         c.After 2 minutes (5 cycles of compressions to ventilations), then the 
                  AED will prompt to reanalyze the rhythm.
                  Note: as the patient is smaller in size, the AED pad placement is
                   best as Anterior/ Posterior. 
God Knows
God Knows