Performing Emergency Automated External Defibrillation
Goal: It is performed correctly without adverse effect to the patient and the patient regains signs of circulation, with organized electrical rhythm and pulse.
1. Assess responsiveness. If the patient is not responsive, call for help and pull call bell, and call the facility emergency response number. Call for the AED. Perform cardiopulmonary resuscitation (CPR) until the defibrillator and other emergency equipment arrive.
2. Prepare the AED. Power on the AED. Push the power button. Some devices will turn on automatically when the lid or case are opened.
3. Attach AED connecting cables to the AED (may be preconnected). Attach AED cables to the adhesive electrode pads (may be preconnected).
4. Stop chest compressions. Peel away the covering from the electrode pads to expose the adhesive surface. Attach the electrode pads to the patient’s chest. Place one pad on the upper right sternal border, directly below the clavicle. Place the second pad lateral to the left nipple, with the top margin of the pad a few inches below the axilla.
5. Once the pads are in place and the device is turned on, follow the prompts given by the device. Clear the patient and analyze the rhythm. Ensure no one is touching the patient. Loudly state a “Clear the patient” message. Press “Analyze” button to initiate analysis, if necessary. Some devices automatically begin analysis when the pads are attached. Avoid all movement affecting the patient during analysis.
6. If ventricular tachycardia or ventricular fibrillation is present, the device will announce that a shock is indicated and begin charging. Once the AED is charged, a message will be delivered to shock the patient.
7. Before pressing the “Shock” button, loudly state a “Clear the patient” message. Visually check that no one is in contact with the patient. Press the “Shock” button. If the AED is fully automatic, a shock will be delivered automatically.
8. After the first shock, check the patient for signs of circulation, including a pulse. If the patient is without signs of circulation, resume CPR for 2 minutes. Rhythm checks should be performed every 2 minutes.
9. After any “no shock indicated” message, or 2 minutes, check the patient for signs of circulation, including a pulse. If no signs of circulation are present, press “Analyze” on the AED. Defibrillate if indicated by the AED. Continue with CPR and AED interpretation until the AED gives a “no shock indicated” message, the patient exhibits signs of circulation, or until ACLS is available. If signs of circulation do not return after an additional shock, resume CPR for 2 minutes.
10. Continue with CPR and AED interpretation until the AED gives a “no shock indicated” message, the patient exhibits signs of circulation, or until ACLS is available.
11. When “no shock indicated” message is received, check for signs of circulation. If signs of circulation are present, check breathing. If breathing is inadequate, assist breathing. Start rescue breathing (1 breath every 5 seconds). If breathing is adequate, place the patient in the recovery position, with the AED attached. Continue to assess the patient.
12. Continue CPR until the patient resumes spontaneous breathing and circulation, medical help arrives, you are too exhausted to continue, or a physician discontinues CPR.