Defibrillator considerations and daily monitor check

Question 1

What are some environmental considerations when using a defib?

Answer 1

• Do not use the defib around flammable agents, oxygen rich atmospheres or anaesthetics
• Do not use the defib on or near water, or on metal surfaces.

Question 2

What are some equipment related safety issues?

Answer 2

• Damaged therapy cables must be replaced
• Do not use dry, damaged, faulty or expired defibrillation pads
• If the monitor is “ready for use” (RFU) indicator is flashing or displaying a circle with a diagonal line through it, install a fully discharged battery and recheck. If it continues flashing or showing the circle symbol, the defib is unserviceable and should be replaced

Question 3

How do you prepare a patients chest for defib pads?

Answer 3

• 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 and wiry. Refrain from shaving as this can cause electrical arcing.

Question 4

Which defib pads should be selected for your patient?

Answer 4

• Paeds pads - <25kg
• CPR feedback pads - >25 kg
• Adult non feedback pads - STEMI

Question 5

How do you apply adult defib pads?

Answer 5

• The “apex” pad is placed on the left, at the mid-auxiliary line, 6th intercostal space.
• The “sternal” pad is rolled on laterally from right sternal margin on the patients right side of chest, under the right clavicle and above the right nipple.
• Feedback pads - the feedback device is placed on the mid-sternal line first. The remaining pad is rolled lateral ensuring final placement is under the right clavicle and above the right nipple. If unable to achieve this position - the feedback device can be separated 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/
• Apply gentle pressure over the entire surface of the gel and adhesive ring to ensure adhesion.

Question 6

How do you apply paediatric pads?

Answer 6

• apply as close as possible to adult placement
• wrapping over the shoulder is permissible to ensure sufficient grip between the pads.
• Avoid the neck

Question 7

What are some application considerations for defib pads?

Answer 7

• Do not place pads over GTN patches, GTN paste, PPM or ECG dogs or cables.
• Avoid skin pigmentations and riddles to prevent burns
• Avoid skin folds to prevent electrical arcing
• Do not allow contact between pads
• Do not perform chest compressions over pads or wires
• Do not defib if the pads are not properly adhering to patient

Question 8

What are some general considerations for defibrillation?

Answer 8

• 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 defib.
• Patients are being transported with mCPR in process and require regular defibrillation, where frequently stopping the ambulance will delay definitive care.
• Performing synchronised cardioversion (MICA only)
• All rhythm checks and defib should be done in manual mode
• All rhythm checks are to be done on screen (printing not required)
• Patients with known or suspected pacemakers should have ECG electrodes applied when time permits and without interruptions to CPR if the paramedic suspects the pacemaker is affecting the underlying rhythm on the initial analysis. This will enable a view of the presence or absence of pacing spikes to confirm if the pacemaker is affecting the underlying rhythm (e.g. capturing or not capturing)
• If using CPR feedback pads, “see through CPR” can be utilised to perform a prelim rhythm check prior to charging.
• Compressions should continue during charging of the defibrillator.
• A final rhythm check must take place once compressions have stopped.
• Where there is uncertainty determining a rhythm needs to be defibrillated 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 leads soft key until the pads view is displayed.

Question 9

How would you describe sinus rhythm? (rate, rhythm, P, PR, QRS)

Answer 9

Rate: 60-100
Rhythm: regular
P waves: present and associated with each QRS
PR interval: 0.12-0.2 seconds
QRS duration: <0.12 seconds

Question 10

How would you describe VF? (rate, rhythm, P, PR, QRS)

Answer 10

Rate: nil discernible
Rhythm: Bizarre, chaotic, amplitude >0.1mV
P waves: nil discernible
PR: nil discernible
QRS: nil discernible

Question 11

How would you describe VT? (rate, rhythm, P, PR, QRS)

Answer 11

rate: greater than 100
rhythm: regular
P: not associated or nil discernible
PR: Nil discernible
QRS: >0.12 seconds

Question 12

How would you describe asystole? (rate, rhythm, P, PR, QRS)

Answer 12

rate: nil discernible
rhythm: no electrical activity, flat isoelectric line, amplitude <0.1mV
P: nil discernible
PR: nil discernible
QRS: nil discernible

Question 13

What is the timing of the squares on the ECG paper?

Answer 13

• 1 small square = 0.4 seconds
• 2 small squares = 0.8 seconds
• 3 small squares = 0.12 seconds
• 4 small squares = 0.16 seconds
• 5 small squares = 0.2 seconds (= 1 large square)

Question 14

What is the cardiac arrest script?

Answer 14

“We’re approaching the end of a 2 minute cycle”
- plan role/position changes and communicate

Perform preliminary rhythm check and state rhythm
“The patient appears to be in (VF) do you agree?” “I agree”

State “Continue compressions, everyone else clear”

Charge monitor and state “Charging to 200 joules”

Tap compressors hands and state “Stop compressions”
- ensure partner moves aside and declares “clear”

Perform final rhythm check and state rhythm
- perform pulse check where indicated and state if present or absent

• State “shocking” or “disarming” and press appropriate button

State “recommence CPR”

Question 15

How do you check the defib/monitor?

Answer 15

• Check the battery on pack
• Check pockets with equipment and ensure everything is not damaged/everything there - 4 lead, 12 lead, smart defib pads, normal defib pads, paeds pads, BP cuffs - adult, Bari, pads, SpO2 monitor for adult and paed, thermometer, shears
• Check battery on screen (not reliable)
• Check date and time
• Check wifi/hotspot is connected
• Check auto check (black octagon = passed, red circle with cross = failed)
• ETCO2 and paper change on L) side of monitor
• Check defib pads - plug into check, dial up 30 joules, shock, green = passed.