3.2 AED operation and safety considerations

AEDs are lifesaving devices that shock the heart back into rhythm during cardiac emergencies. They're designed for easy use by anyone, with voice prompts guiding you through each step. Proper operation and safety are crucial for successful outcomes.

Understanding AED components, shock delivery, and safety considerations is vital for effective use. From electrode placement to scene assessment and patient-specific precautions, knowing these details can make the difference in saving a life during CPR.

AED Components and Operation

Key Components of an AED

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• Automated External Defibrillator (AED) is a portable electronic device used to automatically diagnose and treat life-threatening cardiac arrhythmias through defibrillation
• AEDs contain a battery, capacitor, and computerized circuitry to analyze the heart's rhythm and deliver an appropriate shock when needed
• Electrode pads are adhesive pads applied to the patient's bare chest to allow the AED to monitor the heart rhythm and deliver the shock
  • Pads are placed on the upper right chest and lower left side of the chest
• AEDs use voice prompts and visual indicators to guide the user through the steps of operation (electrode pad placement, when to perform CPR, when to stand clear for shock delivery)

Delivering a Shock with an AED

• Shock delivery occurs when the AED detects a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia) and prompts the user to stand clear and press the shock button
  • Shocks are delivered in a specific joule setting (typically between 120-360 joules for adults) to depolarize the heart muscle and allow it to reset to a normal rhythm
• Most AEDs will automatically analyze the heart rhythm after each shock and prompt for additional shocks if needed
• Pediatric pads or a pediatric key should be used for children under 8 years old or weighing less than 55 lbs to reduce the energy delivered during the shock (typically 50-75 joules)

Scene Safety Considerations

Environmental Hazards

• Scene safety is the first priority when using an AED, rescuers must ensure there are no environmental hazards that could harm the patient or rescuers
  • Hazards may include traffic, unstable structures, fire, or hazardous materials
• Wet environment precautions are necessary as water conducts electricity and can cause the shock to arc or spread to rescuers or bystanders
  • Move patient to a dry area if possible, or ensure no one is touching the patient or standing in any puddles during shock delivery
• Metal surfaces can also conduct electricity and should be avoided during AED use (remove the patient from metal bleachers, gurneys, or chairs if possible)

Ensuring Rescuer and Bystander Safety

• Always loudly state "Clear" and visually check that no one is touching the patient before delivering a shock
• Ensure rescuers and bystanders stand several feet away from the patient during analysis and shock delivery
• If needed, assign a bystander to help keep the area clear and crowd controlled

Patient-Specific Precautions

Medical Devices and Patches

• Implanted medical devices such as pacemakers or internal defibrillators can be damaged by AED shocks
  • Avoid placing electrode pads directly over these devices, move the pad at least 1 inch away from any visible devices
• Medication patches (nitroglycerin, nicotine, pain relief patches) must be removed from the patient's chest before applying electrode pads
  • Patches can block the conduction of the shock and cause skin burns
• Ensure the chest is wiped clean of any residual medication patch adhesive before applying electrode pads

Patient Characteristics Affecting AED Use

• AED use is not recommended for patients under 1 year of age, as the lowest energy setting may still be too high
  • Manual defibrillators should be used for infants, allowing trained providers to adjust the energy setting
• Patients with excessive chest hair may need to have electrode pad sites shaved quickly to allow the pads to adhere and conduct the shock properly
• Patients with large breasts may require a modified pad placement, placing one pad on the upper chest and one on the side of the chest to ensure proper shock conduction

AED Maintenance

Routine Checks and Upkeep

• AED maintenance is crucial to ensure the device is always ready for use in an emergency
• Most AEDs will perform regular self-checks and alert with a chirp or flashing light if maintenance is needed
• AED batteries should be checked monthly and replaced every 2-5 years depending on the model
  • Expired batteries are the most common cause of AED failure
• Electrode pads have expiration dates, typically 2-5 years, and should be checked monthly and replaced as needed
  • Expired or damaged electrode pads can fail to stick or conduct the shock properly

Post-Use Procedures

• After an AED is used on a patient, it must be properly cleaned and decontaminated according to manufacturer guidelines and local protocols
• The AED data should be downloaded by the appropriate personnel for quality improvement review and documentation
  • Most AEDs save data on the patient's heart rhythm, shocks delivered, and CPR intervals that can be useful for the patient's medical record or for training and quality control
• Any used supplies (electrode pads, razors, towels) should be replaced and the AED returned to its storage location for the next use