□ Early defibrillation improves survival outcomes following a cardiac arrest.
□ Healthcare professionals must be skilled in recognising a cardiac arrest and know how to respond effectively.
□ Intervention with rapid defibrillation is an emergency procedure that must be delivered promptly, effectively and safely.
□ The types of defibrillators currently available include manual, automatic and semiautomatic.
□ In the event of a cardiac arrest, if a defibrillator is not immediately available, CPR should be started.
□ Factors impacting on successful cardiac defibrillation include transthoracic impedance, energy requirements, biphasic waveform defibrillation and the effects of drugs.
□ The paddles must stay on the casualty's chest between shocks as this reduces delays to defibrillation.
□ Any healthcare professional responsible for performing BLS must be competent in using an AED and must update regularly.
□ Synchronised cardioversion is usually an elective procedure used to transform tachyarrhythmias of an atrial or ventricular origin into sinus rhythm.
□ During cardioversion it is vital that the 'synch' button is activated. Verification involves checking that the cardiac monitor displays bright synchronising signals/marks over the R waves.
□ Staff operating a defibrillator must always be aware of the potential dangers and hazards that may occur to the patient and bystanders while delivering a shock.
You are working a night shift and decide to get a snack from the vending machine. You arrive at your destination and hear a noise. Slumped on a chair, you find a gentleman who is unrousable and whose shirt is soaked in coffee. What do you do next? Write down what you might do.
You confirm that the patient has arrested and assess for signs of respiration and circulation. If these are absent, get immediate assistance from the nearest ward or telephone, giving the exact location. Return to the casualty and place him in a position to begin basic life support. Use the head tilt, chin lift manoeuvre to open the airway and assess that it is patent.
The AED arrives almost immediately and you switch it on. You remove the casualty's shirt and note that he is wearing a long gold chain. Write down what you would do next.
Remove all jewellery and metal. Dry the casualty's chest as much as possible. Place the sternal gel pad below the right clavicle and the other gel pad lateral to the left nipple with the top of the pad 7 cm below the axilla. Connect the cable to the AED.
What is your next action?
Follow voice and visual directions on the AED. The device instructs you to press the ANALYZE button but first make sure that nobody is touching the casualty. Within seconds, the AED confirms that the casualty is in a shockable rhythm. The voice prompt will then warn all personnel to stand clear. In the meantime, the AED will charge to a pre-set level; you may see this on the screen or hear an audible sound. You will then be advised to press the shock button(s). Before doing so, check your environment and make sure everyone has stepped back and that it is safe to defibrillate the patient. Once the patient has been shocked, reanalyse the rhythm. If the patient is still in VF follow the ALS algorithm (in Chapter 6).
The second shock has been successful, as evident by ECG analysis. What would you do next?
Check the airway then assess for signs of breathing and the carotid pulse for signs of circulation. If the casualty is stable then arrange for transfer to the coronary care unit. During transfer, monitor the ECG, non-invasive blood pressure and oxygen saturation (see Chapter 12). Provide an accurate handover and document all relevant actions/ interventions during the arrest and ensure the next of kin are notified.
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