User:Nobull67/Draft/AED

Draft reworking of parts of Automated external defibrillator

Usage

An automated external defibrillator is used in cases of life threatening cardiac arrhythmias which have led to cardiac arrest. The rhythms the device will treat are usually limited to:

• Ventricular fibrillation (shortened to VF or V-Fib)
• Pulseless Ventricular tachycardia (shortened to VT or V-Tach)

AEDs, as with all defibrillators, are not designed to shock asystole ('flat line' patterns) as this will not have a positive clinical outcome. The asystolic patient only has a chance of survival if, through a combination of CPR and cardiac stimulant drugs, one of the shockable rhythms can be established, which makes it imperative for CPR to be carried out by any lay rescuer prior to the arrival of a defibrillator.

In each of the two types of shockable cardiac arrhythmia, the heart is in activity, yet in an unusual pattern which can be life-threatening if left uncorrected. In ventricular fibrillation, the electrical activity of the heart becomes chaotic, preventing the ventricle from effectively pumping blood. In ventricular tachycardia, the heart beats too fast to effectively pump blood. Ultimately, ventricular tachycardia leads to ventricular fibrillation. The fibrillation in the heart decreases over time, and will eventually reach asystole.

Uncorrected, these cardiac conditions rapidly lead to irreversible brain damage and death. After approximately three to five minutes, irreversible brain/tissue damage may begin to occur. For every minute that a person in cardiac arrest goes without being successfully treated (by defibrillation), the chance of survival decreases by 10 percent.

AEDs are designed to be used by laypersons who ideally should have received AED training. This is in contrast to more sophisticated manual and semi-automatic defibrillators used by health professionals, which can act as a pacemaker if the heart rate is too slow (bradycardia) and perform other functions which require a skilled operator able to read electrocardiograms.

Mechanism of operation

The use of easily visible status indicator and pad expiry date on one model of AED

An AED is external because the operator applies the electrode pads to the bare chest of the victim, as opposed to internal defibrillators, which have electrodes surgically implanted inside the body of a patient.

Automatic refers to the unit's ability to autonomously analyse the patient's condition, and to assist this, the vast majority of units have spoken prompts, and some may also have visual displays to instruct the user.

When turned on or opened, the AED will instruct the user to connect the electrodes (pads) to the patient. Once the pads are attached, everyone should avoid touching the patient so as to avoid false readings by the unit. The pads allow the AED to examine the electrical output from the heart and determine if the patient is in a shockable rhythm (either ventricular fibrillation or ventricular tachycardia). If the device determines that a shock is warranted, it will use the battery to charge its internal capacitor in preparation to deliver the shock. This system is not only safer (charging only when required), but also allows for a faster delivery of the electrical current.

When charged, the device instructs the user to ensure no one is touching the victim and then to press a button to deliver the shock; human intervention is usually required to deliver the shock to the patient in order to avoid the possibility of accidental injury to another person (which can result from a responder or bystander touching the patient at the time of ths shock). Depending on the manufacturer and particular model, after the shock is delivered most devices will analyze the victim and either instruct that CPR be given, or administer another shock.

Many AED units have an 'event memory' which stores the ECG along with the time the unit was activated and the number and strength of shocks. Some units have sound recording abilities to monitor the actions of personnel. All this data can be used to assess the effectiveness of both CPR and defibrillation.

AEDs available to the public may be semi-automatic or fully automatic. Fully automatic units are likely to have few buttons, often activating as soon as the case is opened, and possibly just one button to shock, or in some cases this will be performed automatically. The user has no input in the operation of the unit apart from attaching the pads and following the prompts. Health care professionals and other trained responders may use a semi-automatic defibrillator, which is likely to have an ECG readout display, and the possibility to override the rhythm analysis software. This allows trained personnel to provide a higher level of care.

The first commercially available AEDs were all of a monophasic type, which gave a high-energy shock, up to 360 to 400 joules depending on the model. This caused increased cardiac injury and in some cases second and third-degree burns around the shock pad sites. Newer AEDs (manufactured after late 2003) have tended to utilise biphasic algorithms which give two sequential lower-energy shocks of 120 - 200 joules, with each shock moving in an opposite polarity between the pads. This lower-energy waveform has proven more effective in clinical tests, as well as offering a reduced rate of complications and reduced recovery time.

Simplicity of use

Unlike regular defibrillators, an automated external defibrillator requires minimal training to use. It automatically diagnoses the heart rhythm and determines if a shock is needed. Automatic models will administer the shock without the user's command. Semi-automatic models will tell the user that a shock is needed, but the user must tell the machine to do so, usually by pressing a button. In most circumstances, the user cannot override a "no shock" advisory by an AED. Some AEDs may be used on children - those under 55 lbs (25 kg) in weight or under age 8. If a particular model of AED is approved for pediatric use, all that is required is the use of more appropriate pads. Some organizations, such as the American Heart Association, recommend that if pediatric AED pads are not available, adult pads should be used to determine if the child is in a shockable rhythm. There is insufficient evidence to suggest that a child, in a shockable cardiac arrest, can be "hurt" by an adult defibrillation energy setting.

All AEDs approved for use in the United States use an electronic voice to prompt users through each step. Because the user of an AED may be hearing impaired, many AEDs now include visual prompts as well. Most units are designed for use by non-medical operators. Their ease of use has given rise to the notion of public access defibrillation (PAD), which experts agree has the potential to be the single greatest advance in the treatment of out-of-hospital cardiac arrest since the invention of CPR.

Stuff to work in somewhere

The Resuscitation Council (UK) in The use of Automated External Defibrillators (2005) also states the mid-axillary pad should be oriented vertically. The Council are, presumably, the source of the SJA policy. The document cites Deakin, CD (January 2003). "Is the orientation of the apical defibrillation paddle of importance during manual external defibrillation?". Resuscitation. 56 (1): 15–18. doi:10.1016/S0300-9572(02)00290-3. PMID 12505733. Retrieved 2008-11-09. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help) (Abstract Retrieved on 9 November 2008). As a matter of personal opinion use of the "horizontal/vertical" terminology (both by the Resuscitation Council and Deakin et al) is confusing when the patient is recumbent as they generally are during resuscitation.