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Now let's talk about the skills required for use of an AED, but the patient is a 17-year-old teenager, they're gonna fit in with our adult level protocol when we use an AED, but this is very common. In fact, we've heard about it in the news a lot where you've got these kids, they're somewhere between 14, 18 years old, they're on the court, they're on the field, and they are healthy individuals, seemingly, and then go down in cardiac arrest. So this is the kind of scenario that we're setting up for you, then we wanna show how easy it is to get them the help they need in a rapid form. So here we go: the scene is already safe, CPR has already been in progress and whether we brought the AED or someone else brought it in, the point is it's here and it's ready to use. So let's go ahead and begin, when we have the AED here, the very first thing we're gonna do is turn it on. [AED begins instructions] So it tells us to remove the clothing. Many times they have scissors right in the back. It tells me to attach the pads and plug in the connectors, so I'm gonna work on that. if I open this up, I can see exactly the way these are supposed to go, one goes here and one goes here, just like it shows right on the pads. Now, special note: if they're sweaty, dry them off. If there's any kind of gel, dry it off. If there's jewelry, it doesn't matter if they have piercings, but if they have a necklace and it's in between these two pads, we're gonna move that jewelry just to the side so it's not in the way of the electrical pathway. These are actually sticking quite well so now I'm gonna go to the last step which is plugging in the connector. Make sure not to touch the patient, don't bump them. OK, we allow the AED to charge. Nobody's touching the patient, I discharge. Now, it's important that we go straight into chest compressions, the same way we did CPR, that 2- to 2.4-inch depth, 100 to 120 compressions per minute. We go right over the cable, we go right over the AED pads. We don't remove them, we don't disconnect them, we just do our compressions right over them. We could follow the metronome but it's not necessary; we know how to do these CPR compressions, but we're gonna do the normal CPR. So we're doing our 30 compressions. After the 30 compressions, just like before, we do the head tilt, chin lift, and we give two rescue breaths. Going right back into the chest compressions [7, 8, 9, 10..] 25, 26, 27, 28, 29, 30], followed by two more breaths. Followed by 30 more compressions. When it interrupts, we stand clear and let it analyze for a rhythm. So whether it says a shock is advised, it recharges so that you can shock, or whether it says no shock advised, we're gonna follow its promptings and go right back into whatever it tells us to do. We are going to continue to do this without taking anything off or turning anything off until EMS arrives until the person revives and starts breathing normally, or somebody equally trained or higher comes and relieves us.
In this lesson, we'll cover how to use an AED on an adult victim.
An AED (Automated External Defibrillator) is a portable electronic device that analyzes the rhythm of the heart and delivers an electrical shock, known as defibrillation, which helps the heart re-establish an effective rhythm.
Warning: When using an AED, there are a couple of important things to keep in mind as it relates to your surroundings.
- Are there combustible gases or liquids at the scene?
- Are there any liquids that could connect the victim with yourself, the rescuer, or someone else, that could result in electrocution?
Pro Tip #1: If the scene isn't safe enough to use an AED, drag or move the patient to a safer area where you won't have to worry about explosives or electrocution from water and then use the AED.
These are two important considerations before using an AED, but there are a few other things to note when defibrillating an adult patient.
- If the victim is female and wearing an underwire bra, it shouldn't present any complications. However, if it is a concern, you can disconnect it and remove it from the pathway to the heart.
- Necklaces should be moved to the side.
- Any patches – nicotine, analgesic, nitro gel, etc. – should be removed if they are in the way of the pads.
- Piercings shouldn't cause any problems.
- It's OK if the victim or the victim's clothing is wet, as long as the chest area is dry and you or the victim aren't submerged in water or connected by it.
- There are no special considerations for pregnant women.
Pro Tip #2: It's OK to be just as aggressive with a pregnant woman as you would any other victim. The primary focus should be on the mother, as saving her will also help save the baby. The care you provide to the mother won't put the baby in any more jeopardy.
How to Provide Care
Let's assume a few things:
- The scene is safe, and your gloves are on
- You or a bystander called 911
- You have an AED, whether you found one or had it with you
- The victim is unresponsive and not breathing normally
- CPR is already in progress
Remember, as long as you have your cell phone, you're never alone. If no one is around to help you and you aren't sure what to do, call 911 on your cell phone, put it on speaker, and follow their instructions. Dispatch can help coach you through the situation.
However, when it comes to AEDs, they supply their own instructions. Well, at least after the first step below.
AED Technique for Adults
Pro Tip #3: This is really the anti Pro Tip, as you don't need to be a pro to execute it. The AED will tell you what to do and what it's doing, like "remove clothing" or "analyzing rhythm." All you have to do is follow along.
- Turn on the AED.
- Remove the patient's clothing to reveal a bare chest and dry the chest off if it's wet. (AEDs will typically include a pair of scissors somewhere on the unit.)
- Attach the AED pads to the victim's chest. The pads should have a diagram on placement if you need help. The first pad goes on the top right side of the chest. The second pad goes on the bottom left side of the victim's side, under the left breast. Make sure they adhere well.
- Plug the cable into the AED and be sure no one is touching the victim. The AED should now be charging and analyzing the rhythm of the victim's heart.
- If the scene is clear and no one is touching the victim, push the discharge button to deliver a shock. Then go right back into CPR. It's OK to perform CPR over the pads, so don't worry about moving them.
- Perform 30 chest compressions.
- Grab the rescue shield and place it over the victim's mouth and nose.
- Lift the victim's chin and tilt his or her head back.
- Deliver two rescue breaths.
Continue with CPR until the AED interrupts you. At some point, it will reanalyze the victim's heart rhythm and again advise you on what to do next. If the AED advises a shock, do that. If it advises you to NOT shock the victim, continue with CPR only, again over the pads. (The AED will continue to reanalyze.)
Continue this cycle of CPR, re-analyzation, charging, shock, back into CPR until EMS arrives, the patient is responsive and breathing normally, or someone who's equally trained or better can relieve you.
A Couple Special AED Considerations
There could be special situations that go beyond what you found in the list that opened this lesson. These include using an AED on a victim who's wearing an implantable device and a victim with an excessive amount of chest hair.
Implantable Devices
Implantable devices, like pacemakers, are sometimes located below one of the collarbones in the area where one of the AED pads should go. This can be problematic as the device could interfere with shock delivery.
An ICD (Implantable Cardioverter-Defibrillator) is another common implantable device you may encounter. It's sort of like a mini version of an AED, as it detects abnormal heart rhythms and restores them to normal.
If one of these devices is visible – a small lump can sometimes be seen or felt – or if you know the victim has one in a specific location, do not place the AED pad on top of it. Instead, adjust the placement of the pad to avoid the device.
Excessive Chest Hair
Chest hair rarely interferes with AED pad adhesion, but it is nonetheless a possibility. If the victim has excessive chest hair, press firmly on the pads when placing them on the victim's chest. If you get an error message, like check pads, or something similar, remove them and replace with new pads.
Some of the victim's chest hair will likely come off with the old pads, which may solve the problem. However, if the AED still refuses to work, you'll have to shave the victim's chest (or cut some of the hair) before applying a third round of pads.