EMT Defibrillation
A LWTC/NSCC presentation
Objectives

Understand cardiac arrest physiology and
impact CPR/AED has on patient outcomes
 Demonstrate knowledge and understanding
of AED use in role as the EMT/Defib Tech
in cardiac arrest
Some Statistics

Seattle-King County EMS agencies
responded to 1035 cardiac arrest patients in
2007
 302 (29%) of these patients initially
presented in VF/VT
 Survival rate (post VF arrest) for SeattleKing County is 45%
Goals

Quality CPR is to be performed and
interrupted for a minimal amount of time
 VF/VT to be shocked as soon as
defibrillator is available
 Overall patient care and safety are never to
be neglected
Your Goal…
Basic Cardiac
Physiology
Normal Cardiac Conduction
Electrical pattern
ECG tracing
Cardiac Arrest

Occulsion of the
coronary artery leads
to ischemia
 Ischemia leads to
infarct which causes
interruption of normal
cardiac conduction
 Infarct = VF/VT
Shockable Rhythms
Ventricular Fibrillation
Ventricular Tachycardia
Defib Procedure
Equipment

AED is capable of
analyzing shockable
rhythms
 Delivers biphasic
shock (120-200 joules)
 Can be used for
pediatric pts (< 8) with
adult/pediatric pads
Defibrillation Basics

Shockable rhythm is defined as VF or
unconscious/pulseless VT.
 CPR must be performed with minimal
interruptions except in cases of airway
management (aspiration of emesis)
Defibrillation Basics

Before the AED
can be turned on
the patient must be:
– Unconscious
– Unresponsive
– Apneic
– Pulseless
Defib Procedure

Check for consciousness/responsiveness.
 Access ABCs. If not breathing, open
airway & begin ventilations.
 Check pulse. If pulse not present, initiate
CPR.
 Turn on defibrillator, apply pads, begin
verbal report.
 Allow defibrillator to analyze (stop CPR)
Pad Placement
AED will analyze…
…shockable rhythm of VF/pulseless VT
and deliver command to deliver shock
OR
…non-shockable rhythm and deliver
command to resume CPR
Shock Advised (VF or VT)

Clear patient from head to toe (SAFETY!)
 Deliver single shock
 Immediately begin CPR and continue for 2
minutes.
 Do not delay CPR for pulse check or postshock rhythm analysis.
Shock Advised (VF or VT)

After 2 minutes of CPR, analyze rhythm
(stop CPR)
 No pulse check required
 If shock is indicated, clear patient, and
deliver 2nd shock.
 Continue uninterrupted CPR for 2 minutes
Shock Advised (VF or VT)

After 2 minutes of CPR, analyze rhythm
(stop CPR)
 No pulse check required
 If shock is indicated, clear patient, and
deliver 3rd shock.
 Continue uninterrupted CPR for 2 minutes.
Shock Advised (VF or VT)

After 2 minutes of CPR, analyze rhythm
(stop CPR)
 No pulse check required
 If shock is indicated, clear patient, and
deliver shock.
 Continue uninterrupted CPR for 2 minutes.
 Continue process until Medic arrival
No Shock Advised

Immediately begin CPR
 Continue uninterrupted CPR for 2 minutes
 Do not delay CPR for pulse check
No Shock Advised

After 2 minutes of CPR, analyze rhythm
(stop CPR)
 Do not check pulse before analyzing rhythm
 If No Shock is advised, check pulse.
 No pulse, continue uninterrupted CPR for 2
minutes
No Shock Advised

If pulse is present after pulse check, obtain
patient’s blood pressure, check airway to
ensure it is clear, and assess breathing for
adequate breathing.
 Assist ventilations if inadequate.
 If blood pressure < 60 mmHg systolic,
perform uninterrupted CPR for 2 minutes
No Shock Advised

After 2 minutes of CPR, analyze patient
(stop CPR)
 Do not check pulse before analyzing rhythm
 If No Shock advised, check pulse.
 If no pulse, continue uninterrupted CPR for
2 minutes
 After 3rd No Shock, continue CPR without
analyzing patient
Safety
Safety
 Defib
tech is in charge at ALL times!
 You are responsible for the overall
quality of airway management, CPR,
and safe, effective defibrillation
 Be sure to clear patient from head-totoe prior to delivering shock
Special Circumstances
 Pediatric
patients (< 1 year old)
 Trauma patients
 Hypothermia
Questions?