You go call 9-1-1 get an AED and come back to me - are you going?
So if you've ever had that moment where you've wondered oh my god what would I do if someone
were to call me you to get an AED.
So we're going to talk about what the automated external defibrillator is in this video, we're
going to look at what's inside of here, why we need it why it's so important to use it,
and what we can reasonably expect in terms of outcomes.
Welcome back my name is Tammy and this is NursemMinder and on this channel we do everything
nursing, so if you're new here consider subscribing below so that you get the next video when
it's released.
Now I'll first share that when I teach it's quite fun because as people's nerves get going,
even before we start the class they're nervous because they have to perform at some point.
When I tell them it's an AED, they don't always hear it or let it register and so when they
actually get into their moment and it's their turn to call out somebody I've heard it called
an IED - it is not an it's not an improvised explosive device.
I've heard it called an IUD which always breaks us out in hysterical laughter because an IUD
isn't going to help your heart, but what's most important is they do know what they're
looking for, they actually understand what this is going to do and so and so we're going
to talk about that.
So an AED is a portable device it's really easy to use.
It is meant for anyone to use without training because it will take you and walk you through,
it actually talks to you step by step what you need to do.
Now an AED, A is for automated E external and D is defibrillator - is a portable unit.
A little portable machine inside of this that is used to detect cardiac arrhythmias and
so as we are sitting here talking today, my heart is beating in a rhythm that is perfusing
which means it's contracting to propel blood so that my body can get all the oxygen and
the nutrients that it needs, which is why I'm living and talking and breathing right
now.
When a patient has a cardiac arrest that function stops.
The heart is not beating and there is no blood pumping out so essentially our patients are
dead.
So we want to get one of these on scene ASAP in order to increase the likelihood of survival.
Now in Canada, the latest stats show that there's approximately 40 000 cardiac arrests
annually which averages out to approximately one every 12 minutes, and with that 75 to
80 happen in the community which is why it's so important we know how to do CPR and work
an AED.
Now here's the real, here's the real issue as to why AEDs are so important.
CPR alone is only effective to circulate the blood.
It's not going to convert the heart out of a rhythm that needs to be shocked in order
for the heart to take over and start to do that on its own and so if we combine CPR with
an AED, if that's if we have immediate access to both of those and we can get from onset
of cardiac arrest to the first rhythm within two or three minutes, we have a 75 success
rate.
Now for every minute that ticks by we lose 7 to 10 percent so their survival rate drops
seven to ten percent for every minute that we delay the use of an automated external
defibrillator and so we definitely want to get that right away.
But how do we access it?
Now i know what you're thinking - you're thinking how is it possible for me to get an AED Tammy
if I don't have one in my house?
I can tell you these are trainers they're not real ones I don't have one in my house
either, but what I share with you now is that when you call they 911 have a list of AEDs
nearest you and if there is one close by if all you have to do is run across the street
to the 711 or to the bank or to the grocery store or to the arena, casino any public space
where you are close to they can direct you to that AED, but only if they're registered.
There was a show a while back and I think it was like a W5 or something where they were
downtown Toronto and they were going in to see how many AEDs existed in the buildings
because AED's will be in locations where a large group of people gather that are high
risk and likely to need those services, and what they found was a lot of those AEDs were
actually locked behind security desks so they had to find the security guard to get the
key to open the door to get the AED.
Do you see what that is?
That's time time time time, tick tick tick tick, and a dead person doesn't have time
on their side.
And so that was one of the things they found is that they were not accessible.
The second thing they found was that the AEDs were not registered with 9-1-1 and so if a
patient were to arrest in that building and they were to call 9-1-1 they could not advise
the people to go downstairs or go to the elevator or go to the fourth floor where there was
an AED so that they could get that electricity onto that patient, through that patient fast.
That's a significant problem so if you have an AED and you're watching this maybe you
have one at home or in your company and you haven't registered it with your local emergency
response system please follow up with that and make sure they're aware that you have
that life-saving measure available to you because as good as our emergency response
system is and let me tell you they have a national response time between 8 to 12 minutes
from call to showing up at your door, and you know we want to get that AED on as soon
as possible so if we can get it within that first five to ten minutes in the community
great we have a higher survival rate.
In the hospital, it's even higher standards like within the first two or three minutes
we want that AED pumping electricity if it's required.
But as good as they are sometimes we can get a boost by just knowing that we have these
available to us and that we know how to use them.
So we're going to take care of how to use them next.
So let's look at the components inside of our AED bag.
First we have our machine, and they're not all universal, but you can see from here there's
a one - two - three.
There's also a green button and that's where we would start.
Okay we have our pediatric pads our adult pads and in this case I've put a razor in
here in case you have a razor in your kit.
Now you might be wondering why are there two different sizes of pads our pediatric and
our adults.
So our pediatric is for our 8 and under.
Now we don't always know the age of our patient when they are in front of us so use signs
of puberty which I know, that varies greatly, but if you have somebody who has no signs
of puberty assume they are a child and use the pediatric pads.
You will notice that the placement is different it's going to have you put a pad right here
in the middle of the chest and right here in the back - This is an adult pad (demo)
- but right here in the back.
That's because our pediatric patients, their hearts are still sitting here more midline
they haven't grown and shifted to the left and so for our eight and under the pad placement
is a little different.
For those that are eight and older or puberty and above we're going to use the adult pads.
So when it comes to pad placement on your human, we're gonna go in the patient's right
upper chest, so this is my right upper chest here and it goes under the collarbone and
it's above the nipple and so it's going to sit in that right upper chest, and then the
second pad goes in the left lateral, and so the landmarking for that is twofold.
One is the middle of the armpit, we call it the mid axillary line, come straight down
we're going to go in the middle that's where we want to be on that line, but the second
thing is we want the patient's left nipple, right below and then you're going to put it
on the side.
Now with this positioning, if I were to place my heart in this scenario, now my heart is
behind my ribs, you can see the direct line that the energy has to take to go through
sorry you can see the direct line the energy is taking to go through my heart to hit this
pad and that is why we use anterolateral as the most common commonly placed system for
the pads.
The second most common is the anterior-posterior and so the heart is on the left side of the
chest it's down here at ribs three four and five which is kind of nipple line.
You would place that pad just left of the midline, so this is the sternum that really
hard bone that goes all the way down your chest, just left of that at the nipple, okay,
and then you're going to turn your patient around and you'll notice where the where the
shoulder bone ends here you're going to put it right underneath
and so this way the heart oops you're gonna put it right underneath
and this allows the electricity to go through the heart okay.
This would be anterior posterior.
So let's show you the anterolateral on manny.
You can see here on the mannequin that we do have the Antero (anterior) which is the
right upper chest, under the clavicle but usually above the nipple, that's kind of where
it sits, and then we have the lateral pad which sits in the mid axillary line so that
is on the side of the patient again we use the nipple as our landmark we go directly
below but most importantly to the side.
Now there are some special considerations to keep in the forefront of your mind.
If you have a patient who is male and they have a lot of hair on their chest when you
put this pad on your machine might continually say check pads check pads and that's because
the electrodes or the pad is not able to actually press down on the skin because the hair is
so thick it's pushing it up and so every time you push it down you squish the hair but it's
going to rise up and we don't get really good contact and so if that happens and you're
getting a check pad you're going to take this pad and rip it off.
Don't be kind.
Don't go oh my gosh oh my gosh my gosh I'm so sorry.
You want to rip it off and expose the skin and then place a new set of pads there.
The second consideration is if they're wet.
So you can't use these in water.
You can't use these if the patient's skin is drenched in sweat you need to wipe off
that area because water is a good conductor of electricity and we don't want that.
So you're going to wipe off this area and then put your pad on.
Now here's the question - if they're outside and it's raining if they're in a puddle if
it's winter time can I use it?
The answer is yes.
If they're in a small puddle, if it is snow you can definitely use the AED pads.
The there's no real qualifier though as to what what makes a small puddle and so my lifeguard
students who've come through training have shared with me that if they splash that puddle
and there is you know splash up that's considered too big and they'll move the patient out of
the puddle.
And the last consideration is the medication patch.
They're often clear and so they're hard to see but if you have somebody who has a medication
patch maybe they take nitro for their heart or they're on a smoking cessation patch or
a hormone patch or fentanyl or morphine for pain and we would put our pad on top of it
- it's going to block the energy and it actually can cause burns to the skin.
So let's say I have a medication patch and it's in my right upper and I notice it.
I need to remove it first before I put my pad and that's to prevent any delay of electricity
or reduction of electricity going through the heart.
Now the most important step with an AED is to simply turn it on.
Apply pads to patient's bare chest, plug-in pad connector next to flashing light
apply pads, plug in connector
analyzing heart rhythm do not touch the patient
shock advised
charging stay clear of patient
deliver shock now press the orange button now, I'm clear your clear.
Shock delivered.
Begin CPR
Now what you're hearing there is the actual rate of compressions and so you won't you
do not want to go slower than that beeping sound but you can go a little faster as we
do have some flexibility in the speed but not so fast that our compressions become ineffective.
All right so what rhythm is it looking for?
The AED is so sophisticated that it can actually discern if your rhythm is perfusable or not
and really what it's looking for in particular to help with that is it's recognizing that
there is all this chaotic energy happening inside the heart we call that ventricular
fibrillation which is why it's called a defibrillator.
Okay so I liken it to fireworks on the fourth of July or the first of July, depending on
where you live, the States or Canada, and how they're just like boom boom boom boom
up in the sky the same thing is happening with the electricity inside your heart.
It's just like going crazy and it's from the ventricles that it's being uM coordinated
from the ventricles so it's not actually coming from the top of the heart down, it's coming
from the bottom of the heart up, and it's just like chaotic and crazy in there and what
happens is the heart actually can't compress, it actually can't contract, it can't circulate
blood because the signals are so wild and when the machine detects that kind of electrical
pattern inside your heart it will say shock advised, because what science has shown us
is that when we give a shock it helps to coordinate the electrical action that's happening inside
the heart but it's not a guarantee.
I liken it to - to give you another analogy - if you've ever - I like analogies -if you've
ever worked with somebody who is overwhelmed, panicked, full of anxiety, not really knowing
what to do and they're like oh my god I don't know what to do.
I gotta take the dog,and I gotta have the kids, I gotta make supper I gotta do my homework
and I go oh I don't know where to start those kind of personalities you kind of wanna reset
them, help them focus and you might wanna go - all right let's just think about one
thing at a time here.
Right it's the same thing with the heart.
The heart's in there going crazy crazy crazy shock comes.
BOOM Let's focus on one thing at a time - you have a job to do.
Ideally we get the conversion but that's not a guarantee as I mentioned and if we don't
get that conversion then we continue on with our CPR and our AED will reassess every two
minutes.
So we call that rhythm ventricular fibrillation because the ventricles are in charge of the
electrical current and it's fibrillating or quivering inside the body which is why the
automated external - meaning the pads are on the skin - defibrillator helps it to return
out of fibrillation into a perfusing rhythm.
It's fascinating isn't it?
So here's a question I get asked a lot.
After the AED shocks do I need to do a pulse check?
The answer is no.
Once the AED delivers its shock you need to get right back into CPR and here's the rationale:
after a shock is delivered we don't consider the heart to be strong enough to maintain
any perfusing rhythm so we're going to give it two minutes of CPR and then reassess.
If it is still in a perfusing rhythm bonus we won't have to shock again and we can continue
to just monitor our patient and reassess every two minutes for breathing and heart rate to
make sure they're still doing the things they need to do to survive.
Right - you dead people.
That's your AED lesson.
Make sure you're aware that if there's an AED located nearby how can you access it.
Take note of your workplaces and identify where are they located.
They're most commonly by elevators and by security so check in with those people and
say hey if I needed one is this where I would come?
And then become familiar with the one that you have - ask them if they can open it up
so you can see.
Now I will share with you when they do open that up in an emergency that door there will
be an alarm that screeches
I don't know what it's going to sound like I just know there's an alarm that that screeches
and there's a very good reason.
That alarm is going to gather your tribe.
People should come running to see what's going on and that is when you get support to call
9-1-1, to help with CPR, to put the AED on because nobody wants to be alone when there's
a code.
Hey I know you're probably not ready to get off your phone or go back to work just yet
or maybe even turn the lights off to go to sleep so why don't you spend a little bit
more time here watching another video