Defibrillation and Resuscitation Competency Flashcards
What are some environmental factors that you need to consider re: safety
- do not use the defibrillator around flammable agents, oxygen rich atmospheres or anaesthetics
- Do not use defib on or near water or on metal surfaces
What are some equipment related issues that you need to consider re: safety
- damaged cables must be replaced
- do not use dry, damaged, faulty or expired pads
- if the monitor “ready for use” indictor is flashing or displaying a circle with a diagonal line through it, install a fully charged battery and recheck. If it continues flashing or showing the circle symbol, the defib is unserviceable and should be replaced
What are some patient/chest preparation factors that you need to consider re: safety
- wipe moist or sweaty skin with a dry towel only - do not use betadine or alcohol wipes as they can cause burns and interfere with pad adhesion
- clip chest hair only when coarse, dense or wiry. Refrain from shaving as this can cause electrical arcing
What issues may you encounter when applying the defib pads?
- PPM
- GTN patches or paste
- patient may be wet/diaphoretic
- body rolls
- anatomical issues
Demonstrate the appropriate defibrillation processes (please include verbal and physical cues)
Demonstrate the appropriate disarming processes (please include verbal and physical cues)
What are the relevant contraindications of defibrillation?
- compelling reason to withold resuscitation or no prospect of resuscitation????
Explain the different types of pads and why you would select them for each patient.
- paed defib pads should be used in patients <25kgs (up to and including 8 yo)
- CPR feedback pads should be used in patients >25kgs
- Adult non-feedback pads are to be used in patients presenting with STEMI or requiring cardioversion
What is the correct technique of applying defibrillation pads (normal adult pads)?
- The apex pad is placed to on the left. at the mid-axillary line, 6th intercostal space
- The sternal pad is to be rolled on laterally from right sternal margin on the patients right chest, under the right clavicle and above the right nipple
- apply the pads in a rolling motion to avoid air pockets
- smooth the pads into the intercostal spaces of thinly built people
- apple gentle pressure over the the entire surface of the gel and adhesive ring to ensure adhesion
- wrapping over the shoulder is permissable to ensure sufficient gap between the pads
- avoid the neck
What is the correct technique of applying defibrillation pads (high performance CPR pads)?
- place the feedback device first on the anterior median (mid-sternal) line
- the remaining pad is then rolled laterally ensuring dinal placement is under the right clavicle and above the right nipple
- if not able to achieve this position the feedback device can be separated from the sternal pad to facilitate accurate placement
- apply the pads in a rolling motion to avoid air pockets
- smooth the pads into the intercostal spaces of thinly built people
- apple gentle pressure over the the entire surface of the gel and adhesive ring to ensure adhesion
- wrapping over the shoulder is permissable to ensure sufficient gap between the pads
- avoid the neck
What is the technique of applying defib pads in a paediatric?
- use the AP position when applying paediatric pads?
- the anterior pad is to be placed mid-chest immediately to the left of the sternum
- the posterior pad is to be placed in the middle of the back between the scapulae
What are some additional considerations for the application of defibrillation pads?
- do not place defib pads over GTN patches, GTN paste, implanted PPM or ECG electrodes and/or cables
- avoid skin pigmentations and nipples to prevent burns
- avoid skin folds to prevent electrical arcing
- do not allow contact between the defibrillation pads and/or ECG electrodes or cables
- Do not defibrillate if the defib pads are not properly adhering to the patient
What are some general defibrillation considerations?
- Do not defibrillate when there is any patient movement, stretcher movement or the ambulance is not stationary, except when:
- patient suffers cardiac arrest during transport, where the process of safely parking the ambulance may cause a delay to defibrillation
- patients are being transported with mechanical CPR in progress and require defibrillation, where frequently stopping the ambulance will delay defininitive care
- All rhythm checks and defibrillation should be done in manual mode
- All rhythm checks are to be done on screen (printing not required)
- Patients with known or suspected PPM should have ECG electrodes applied when time permits and without interruptions to CPR if the paramedic suspects the PPM is affecting the underlying rhythm on initial analysis. This will enable a view of the presence or absense of pacing spikes to confirm if the PPM is affecting the underlying rhythm e.g. capturing vs not capturing
- If using CPR feedback pads, “see through CPR” can be utilised to perform a preliminary rhythm check prior to charging
- Compressions should continue during charging of the defib
- a final rhythm check must take place once compressions have stopped
- where there is uncertainty determining if a rhythm needs to be shocked then the preference is to defib
- WHen a patient is being monitored with electrodes and the defib pads are then applied and connected to the therapy cable, if the monitor displays lead fault, cycle through the leads using the lead soft key until the pads view is displayed
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What is the formula for selecting joules to defibrillate a paediatric patient based on their age?
Patients ages 0-15
- Weight x 4 = joules
- maximum joules is 200
How do you calculate a paeds patients weight?
aged 1-9
weight = (age x 2) + 8
ages 10 or 11
weight = age x 3.3
round the weight off to the normal mathematical rules = 36.3 rounded to 36
Explain the characteristics of VF
- Ventricular rate: Nil discernible
- Ventricular rhythm: Bizarre, chaotic, amplitude > 0.1mV
- P waves: nil discernible
- PR interval: Nil discernible
- QRS duration: Nil discernible
Explain the characteristics of VT
- Ventricular rate: > 100bpm
- Ventricular rhythm: Regular
- P waves: Not associated or nil discernible
- PR interval: nil discernible
- QRS duration: > 0.12 seconds
Explain the characteristics of Asystole
- Ventricular rate: nil discernible
- Ventricular rhythm: no electrical activity, flat isoelectric line, ampiltude < 0.1mV
- P waves: Nil discernible
- PR interval: Nil discernible
- QRS duration: Nil discernible
Explain the characteristics of normal sinus rhythm
- Ventricular rate: 60-100 bpm
- Ventricular rhythm: regular
- P waves: present, associated with each QRS
- PR interval: 0.12-0.2 seconds
- QRS duration: < 0.12 seconds
What are the shockable rhythms?
VT and VF
On the ECG paper, what does one small square equal to in seconds?
0.04 seconds
On the ECG paper, what does one LARGE square equal to in seconds?
0.2 seconds
On the ECG paper, what do 5 large squares equal to in seconds?
1 second
What is the process of checking a Zoll defibrillator
Prepare and inspect equipment
1. Inspect unit and accessories for physical damage
2. Check all cables, cords and connectors for damaged insulation, frayed wires or bent connector pins
3. Check sensors for excessive wear or contamination. Ensure connectors engage securely
Check disposables
4. Ensure that all disposable items (ECG paper, defib pads, ECG electrodes, etc) are available and in work-ready condition
5. Ensure sufficient paper in the machine
6. Ensure one set of adult and one set of paediatric defibrillation pads are present, in date and sealed (to prevent drying out). Spare sets should be stored in the response vehicle
- Note: changing the paper in the Zoll may require more time due to access to the printer - it is important to check this prior to use
Inspect the “Ready to use” indicator
7. Confirm that the Ready for Use indicator is displaying a solid hexagon
8. If it is flashing or displaying a circle with a diagonal live through it , install a fully charged battery and recheck. If it continues flashing or showing the circle symbol the defib is unserviceable and should be replaced
Turn the monitor on
9. The monitor will conduct a self-test on various systems. After a few seconds it should indicate “self test passed”. If it indicated “self test failed” the defibrillator is unserviceable and should be replaced
10. Confirm the date and time are correct (this is important for auditing purposes)
Check batteries
11. Cofirm that the battery in the unit is sufficiently charged and that there is a spare battery available. The number on the battery reflects how many hours of battery life are left. Local conditions and average case times may dictate different definitions of what is sufficient at different AV locations
- Ideally both batteries should be fully charged at the start of the shift
Check leads
12. With no ECG leads attached to the unit select lead I, II or III as the waveform source. Confirm “lead fault” message appears.
Defibrillation test
13. Select pads as the waveform source prior to connecting the multifunction cable to test load unit. Confirm “check pads” message appears
14. Connect the multifunction cable to the test connector. Confirm that the “check pads” message is replaced by the “short detected” message.
15. Use the “energy select” arrows to choose 30 joules to test the unit
16. Press the “charge” button. Confirm that a periodic tone sounds while charging and becoming a solid tone once charged. The charge time shoud be less than 7 seconds and the “shock” button should be illuminated when completed
17. Press and hold the “shock” button until the unit discharges. Confirm that the display shows “defib short test passed”. If the display shows “defib shrt test failed” the defibrillator is unservicable and should be replaced.
Printer test
18. Press “printer” key. Confirm that the printer is working and press the printer key to stop it again
Update distribution list
19. When the mobile phone is turned on and in the vicinity of the monitor it will automatically wirelessly tether to it. The icon shown (dandelion) demonstrates it has connectivity.
20. Navigate to the wireless icon by using the navigation keys, then push the select key
21. Navigate to “update distribution list” using the navigation keys then push select
22. The monitor displays “trying to connect to network” then “transmitting” then “transmission complete”
23. Push the home key to exit the wireless menu
24. Turn the defibrillator off
[](http://https://cpg.ambulance.vic.gov.au/assets/pdf/CWI/CWI%20OPS%2016
When do you complete a check of the Zoll defibrillator?
- at the start of shift
- aquisition of a new monitor
- following resuscitation
- any faults noted
On the assessment, what lead should you view the rhythm strip from?
Lead II
How do you change the date and time on a zoll?
To check in class
How do you appropriately assess someone that is unconscious
- voice
- pain = bilateral trap squeeze or bilat nail bed pressure
Go through the CPR script
