Automated external defibrillation

Question 1

Non-shockable rhythm examples

Answer 1

-asystole- flat line
-pulseless electrical activity- cardiac arrest in presence of electrical activity that would normally be associated with a palpable pulse, normal ECG
-agonal rhythm- flat line with an odd rise and fall

Question 2

Shockable rhythms

Answer 2

-ventricular fibrillation- wavy ECG line, starts course turns fine the longer it goes on for
-pulseless ventricular tachycardia- ventricles are beating really fast

Question 3

Biphasic defibrillation

Answer 3

-electrical current flows in two directions to shock the heart
-goes from each pads at slightly different times to make sure all cells are defibrillated
-adjusts energy according to resistance between chest pads

Question 4

Why early defib is so important
(stats and how to improve window of opportunity)

Answer 4

-chance of successful defib diminishes 7-10% with every minute after collapse
-good quality CPD improves the window of opportunity

Question 5

AED sequence

Answer 5

-unresponsive?
-open airway, check breathing and pulse
-CPR, attach defib pads
-AED analyses rhythm
-non-shockable- resume CPR for 2 mins
-shockable- remove O2, check clear, 1 shock, immediately resume CPR for 2 mins

Question 6

Pad placement

Answer 6

Sternal apical placement
-under right clavicle (sternal) and left mid-axillary line (apical) (lower rib cage, near armpit)

Question 7

Steps for sticking pads

Answer 7

-remove clothing from chest
-remove excessive hair if necessary
-clean and dry skin
-don’t apply any substances or cleansers to skin
-remove medication patches if in the way prior to pad placement

Question 8

post ROSC management (restoration of spontaneous circulation)

Answer 8

-re-assess airway and adequacy of breathing- ventilate if required
-full set of obs
-titrate O2 to 94-98%, if trauma give 100%
-measure ETCO2 want 4.5-5 kPa
-address reversible causes
-avoid hypotension eg. administer NaCl
-12 lead ECG
-avoid bradycardia- give atropine
-manage blood glucose- between 4-10 mmol/l
-manage post ROSC seizures with diazepam
-passive cooling

Question 9

Conditions when resus can be discontinued without ALS

Answer 9

-if cardiac arrest was of natural cause or ‘expected’ and a valid DNACPR (do not attempt resus)
-if asystole and either: unwitnessed collapse thought to be longer than 10 mins ago; absence of bystander CPR for longer than 10mins; co-morbidities eg. cancer, heart failure, dementia etc

Question 10

Conditions when resus can be discontinued following ALS

Answer 10

-once ALS has commenced and patient remains in continuous asystole or agonal rhythm for at least 20 mins, providing at least 30 mins of treatment time given

Question 11

ReSPECT form

Answer 11

Recommended summary plan for emergency care and treatment
- creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they do not have capacity to make or express choices
-include a recommendation on
whether or not CPR should be attempted if the person’s heart and breathing stop

Question 12

Recognition of life extinct (ROLE)

Answer 12

-massive cranial and cerebral destruction
-hemicorporectomy (body cut in half) or similar massive injury
-decomposition
-incineration- severe burns
-hypostasis- blood pools after death in lowest parts of body
-rigor mortis- stiffening of body after death
-foetal maceration- when foetus has died in the womb and is expelled from the body