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Automated External Defibrillator (AED)

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Clyde

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Automated external defibrillator

An automated external defibrillator or AED is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of electrical therapy which stops the arrhythmia, allowing the heart to reestablish an effective rhythm.

With simple audio and visual commands, AEDs are designed to be simple to use for the layman, and the use of AEDs is taught in many first aid, first responder, and basic life support (BLS) level CPR classes.

Usage

Conditions that the Device Treats

An automated external defibrillator is used in cases of life threatening cardiac arrhythmias which lead to cardiac arrest. The rhythms that the device will treat are usually limited to:
  1. Pulseless Ventricular tachycardia (shortened to VT or V-Tach)
  2. Ventricular fibrillation (shortened to VF or V-Fib)
In each of these two types of shockable cardiac arrhythmia, the heart is active, but in a life-threatening, dysfunctional pattern. In ventricular tachycardia, the heart beats too fast to effectively pump blood. Ultimately, ventricular tachycardia leads to ventricular fibrillation. In ventricular fibrillation, the electrical activity of the heart becomes chaotic, preventing the ventricle from effectively pumping blood. The fibrillation in the heart decreases over time, and will eventually reach asystole.

AEDs, like 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 prior to the arrival of a defibrillator.

Effect of Delayed Treatment

Uncorrected, these cardiac conditions (ventricular tachycardia, ventricular fibrillation, asystole) 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 7 percent per minute in the first 3 minutes, and decreases by 10 percent per minute as time advances beyond ~3 minutes.

Requirements for use

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.

Bras with a metal underwire and piercings on the torso must be removed before using the AED on someone to avoid interference. American TV show Mythbusters found evidence that use of a defibrillator on a woman wearing an underwire bra can lead to arcing or fire but only in unusual and unlikely circumstances.

A study analyzed the effects of having AEDs immediately present during Chicago's Heart Start program over a two year period. Of 22 individuals 18 were in a cardiac arrhythmia which AEDs can treat (Vfib or Vtach). Of these 18, 11 survived. Of these 11 patients, 6 were treated by good Samaritan bystanders with absolutely no previous training in AED use.

Placement and Availability

Automated external defibrillators are generally either held by trained personnel who will attend events or are public access units which can be found in places including corporate and government offices, shopping centres, airports, airplanes, restaurants, casinos, hotels, sports stadiums, schools and universities, community centers, fitness centers, health clubs, theme parks, workplaces and any other location where people may congregate.

Maimonides Medical Center in Borough Park, Brooklyn was the first hospital in the United States to implement fully automated external defibrillators at the bedside.

The location of a public access AED should take in to account where large groups of people gather, regardless of age or activity. Children as well as adults may fall victim to sudden cardiac arrest (SCA).

In many areas, emergency vehicles are likely to carry AEDs, with some ambulances carrying an AED in addition to manual defibrillators. Police or fire vehicles often carry an AED for first responder use. Some areas have dedicated community first responders, who are volunteers tasked with keeping an AED and taking it to any victims in their area. AEDs are also increasingly common on commercial airliners, cruise ships, and other transportation facilities.

High-rise buildings are densely populated, but are more difficult to access by emergency crews facing heavy traffic and security barriers. It has been suggested that AEDs carried on elevators could save critical minutes for cardiac arrest victims, and reduce their deployment cost.

In order to make them highly visible, public access AEDs are often brightly colored, and are mounted in protective cases near the entrance of a building. When these protective cases are opened or the defibrillator is removed, some will sound a buzzer to alert nearby staff to their removal, though this does not necessarily summon emergency services; trained AED operators should know to phone for an ambulance when sending for or using an AED. In September 2008, the International Liaison Committee on Resuscitation issued a 'universal AED sign' to be adopted throughout the world to indicate the presence of an AED, and this is shown on the right.

A trend that is developing is the purchase of AEDs to be used in the home, particularly by those with known existing heart conditions. The number of devices in the community has grown as prices have fallen to affordable levels. There has been some concern among medical professionals that these home users do not necessarily have appropriate training, and many advocate the more widespread use of community responders, who can be appropriately trained and managed.

Typically, an AED kit will contain a face shield for providing a barrier between patient and first aider during rescue breathing; a pair of nitrile rubber gloves; a pair of trauma shears for cutting through a patient's clothing to expose the chest; a small towel for wiping away any moisture on the chest, and a razor for shaving those with very hairy chests.

Preparation for operation

Most manufacturers recommend checking the AED before every period of duty or on a regular basis for fixed units. Some units need to be switched on in order to perform a self check; other models have a self check system built in with a visible indicator.

All manufacturers mark their electrode pads with an expiration date, and it is important to ensure that the pads are in date. This is usually marked on the outside of the pads. Some models are designed to make this date visible through a 'window', although others will require the opening of the case to find the date stamp.

It is also important to ensure that the AED unit's batteries have not expired. The AED manufacturer will specify how often the batteries should be replaced.

Mechanism of operation

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 patient 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 the shock). Depending on the manufacturer and particular model, after the shock is delivered most devices will analyze the patient and either instruct CPR to be given, or administer another shock.

Many AED units have an 'event memory' which store the ECG of the patient along with details of the time the unit was activated and the number and strength of any shocks delivered. Some units also have voice recording abilitiesto monitor the actions taken by the personnel in order to ascertain if these had any impact on the survival outcome. All this recorded data can be either downloaded to a computer or printed out so that the providing organisation or responsible body is able to see the effectiveness of both CPR and defibrillation. Some AED units even provide feedback on the quality of the compressions provided by the rescuer.

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.

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.

The number of people who survive sudden cardiac arrest is increasing gradually, thanks to the use of AEDs. For this reason, the Sudden Cardiac Arrest Foundation developed the National SCA Survivor Network, which provides a platform for mutual support and for engaging in the mission to help save other lives.

Liability

Automated external defibrillators are now easy enough to use that most states in the United States include the "good faith" use of an AED by any person under Good Samaritan laws. "Good faith" protection under a Good Samaritan law means that a volunteer responder (not acting as a part of one's occupation) cannot be held civilly liable for the harm or death of a victim by providing improper or inadequate care, given that the harm or death was not intentional and the responder was acting within the limits of their training and in good faith. In the United States, Good Samaritan laws provide some protection for the use of AEDs by trained and untrained responders. AEDs create little liability if used correctly; NREMT-B and many state EMT training and many CPR classes incorporate or offer AED education as a part of their program. In addition to Good Samaritan laws, Ontario, Canada also has the "Chase McEachern Act (Heart Defibrillator Civil Liability), 2007 (Bill 171 – Subsection N)", passed in June, 2007, which protects individuals from liability for damages that may occur from their use of an AED to save someone's life at the immediate scene of an emergency unless damages are caused by gross negligence (Wikimedia Foundation, Inc., 2012).
 

Clyde

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I have used these machines and have saved a couple of lives with them. I highly reccomend peole having one especially is someone in your family or group has hypertension (high blood pressure).
 

Krime

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i had to take de-fib/firstaid/cpr when i was in the plumbers union, they are pritty easy to use as well
 

Clyde

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i had to take de-fib/firstaid/cpr when i was in the plumbers union, they are pritty easy to use as well
They are super easy to use, and the only way someone could screw it up is if the patient was laying in water when they get lit up!
 

Loomis

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I have an implanted Cardiac Defibrillator. I've had mine for 6 years and I am due for a battery change in Jan/Feb next year. I have a device that every Fri. it starts to blink and this female germanic voice says "IT'S TIME INTERROGATE" , I call it Gertrude. But what it does is reads my device and sends it on to the VA. It gives them a print out of my heart rhythms for the past week. I have kind of a love/hate relationship with this chunck of Titanim in my chest. If it detects an arrhythmia it shockes the heart with 800 Jewels. I hear it's pretty powerful. Mine has never gone off! (knock on wood).
So if anyone has any questions about it just ask.

Better to prepare for Nothing, then be unprepared for Something.
 

Krime

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I have an implanted Cardiac Defibrillator. I've had mine for 6 years and I am due for a battery change in Jan/Feb next year. I have a device that every Fri. it starts to blink and this female germanic voice says "IT'S TIME INTERROGATE" , I call it Gertrude. But what it does is reads my device and sends it on to the VA. It gives them a print out of my heart rhythms for the past week. I have kind of a love/hate relationship with this chunck of Titanim in my chest. If it detects an arrhythmia it shockes the heart with 800 Jewels. I hear it's pretty powerful. Mine has never gone off! (knock on wood).
So if anyone has any questions about it just ask.

Better to prepare for Nothing, then be unprepared for Something.
what would happen if you were showering and it went off?
 

Loomis

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what would happen if you were showering and it went off?
Krime,
Oh you'd know it alright. It's quite a wallop. People have told me that's it's like getting kicked in the chest.
One guy I know was riding his bicycle and his went off. It flipped him right over the handle bars onto the pavement. People who saw it said he just took off. Another guy I know said he was riding his motorcycle on the Interstate and his went off. He managed to hold on and stop it although he did end up in a ditch doing so.
If you've ever seen the external ones at work you'll see the guys body jump off the ground.
 

Loomis

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Krime,
Oh you'd know it alright. It's quite a wallop. People have told me that's it's like getting kicked in the chest.
One guy I know was riding his bicycle and his went off. It flipped him right over the handle bars onto the pavement. People who saw it said he just took off. Another guy I know said he was riding his motorcycle on the Interstate and his went off. He managed to hold on and stop it although he did end up in a ditch doing so.
If you've ever seen the external ones at work you'll see the guys body jump off the ground.
Let me Revise this. It's been a while since I had De-Fib 101:
Sorry,
How an implanted ICD works is that it monitors the heart for an Arrhythmia. If it detects one, then it paces it. If the Arrhythmia does not subside it comes off with a very slight shock. This you may not feel. If it continues it gives another shock, you will feel this. It's half a full shock. If it does not stop it, it gives the full shock. That's the one with the Wallop.
Sorry, I forgot that.

Better to Prepare for Nothing, then be unprepared for Something.
 

Loomis

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I am presently doing research on the effects of an EMP on External/Internal Pacemaker/Defibrillator.
So far I have found that some devices have an overload feature which would prevent any damage to the device. But that's all I have right now and it's kind of skechy. I need to contact the manufacturer of mine and find out more. I will post a follow up.
 

Loomis

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I am presently doing research on the effects of an EMP on External/Internal Pacemaker/Defibrillator.
So far I have found that some devices have an overload feature which would prevent any damage to the device. But that's all I have right now and it's kind of skechy. I need to contact the manufacturer of mine and find out more. I will post a follow up.
I just emailed Boston Scientific. Lets see what we get back.

***************************************************
1355 Hrs.
I just recieved a call from Boston Scientific in reguards to my question I sent about the effects of an EMP on my implanted device e.g. Vitality 2.
I spoke with a VERY knowlegeable female engineer. She told me that any EMP or Solar Flare can disrupt the internal settings briefly however the unit itself would correct it back to the original settings. These devices have settings that the Doctors can use to taylor the device to the patients conditon. So that's the answer. That was a fast responce.
I'm also fortunate to know the engineer that designed my device, he's a personal friend of mine. :D Looks like my friend thought of everything.


Better to be Prepared for nothing, then Unprepared for something.
 

Loomis

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After the Dr.'s at the VAMC put in my ICD I was attending and ICD support group at the VA (Veterans Hospital). In time I was giving classes on it. I also wanted a Ham License which brought up RFI (Radio Frquency Interference) issues. Certain Radio Transmissions could and would affect my ICD. At the time there was no information on how far away I need to be from the point of transmission in order to be safe. Until recently Medtronic (a company that makes Cardiac Devices) came up with guidelines. So if you have an external/internal cardiac device you need to know this:
See the chart below.
Medtronic
RADIO FREQUENCY TRANSMISSION
Rev B, 16-FEB-2009
The following guidelines are suggestions for safe use of radio equipment: Power in Watts
Minimum Distance of device from Antenna
Example(s)
3 watts or less
6 inches (15 cm)
Cellular Telephone, Cordless Telephone, Cordless Microphone, Home wireless electronics, Smart key/Remote car starter
>3 – 15
12 inches (30 cm)
Citizens Band, Long Range Cordless Telephone, Invisible Fences, Walkie-Talkies
>15 – 30
24 inches (60 cm)
Marine band radios, GPS survey equipment, some jobsite radios
>30 – 50
3 feet (1 meter)
Commercial and government dispatch, e.g. taxis, emergency vehicles
>50 – 125
6 feet (2 meters)
>125 – 250
9 feet (3 meters)
Commercial broadcasting towers, Ham Radio
>250 – 500
12 feet (4 meters)
>500 – 1000
20 feet (6 meters)
>1000 – 2000
30 feet (9 meters)
>2000
No exposures >100V/meter
High power broadcast towers

This is the current accepted distance for persons with cardiac devices.
Better to be prepared for nothing, then unprepared for something
 

anoymous

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They are super easy to use, and the only way someone could screw it up is if the patient was laying in water when they get lit up!
or your patient has their chest wired shut, then they light up like a christmas tree
 

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