Notes

AED for Adults and Older Children

What Is an AED?
-An AED is a portable medical device that automatically analyzes a victim’s heart rhythm during a cardiac arrest and determines if it is a shockable rhythm. The AED can then deliver an electrical shock in an attempt to re-establish a normal heart rhythm.
-AEDs will recommend shocking victims of cardiac arrest with two specific types of arrhythmias: ventricular fibrillation (VF) and ventricular tachycardia (VT). AHA statistics show that about 25% of OHCA victims have shockable arrhythmias.
-Early use of an AED greatly increases the victim’s chance of survival. Over 50% of cardiac arrest victims who receive rapid defibrillation survive to hospital discharge.

Using an AED for Adults and Children Aged 8 Years and Older
There are several AED manufacturers, each with many different models. Although there are some differences between the models, they all basically operate the same way and provide voice instructions when used during a cardiac arrest.
Use the following steps to operate an AED for adults and children aged 8 years and older:
1. Position and power-on the AED.
2. Attach the AED pads.
3. Allow the AED to analyze the heart rhythm.
4. Deliver a shock, if advised by the AED.
5. Immediately restart chest compressions.
6. Repeat rhythm analysis when prompted by the AED.
Let’s take a closer look at each step.

Step 1 – Position and Power on the AED
Once the AED arrives, it should be positioned at the victim’s side, next to the rescuer who will operate it.
For a two-person rescue, this is the rescuer who is NOT providing chest compressions. This allows the AED to be set up and operated with minimal interruption to chest compressions.
Some AED models have a cover and power on automatically when the cover is opened. If the AED does not power on automatically, turn it on manually. Follow the AED voice commands as a guide to your next steps.


Step 2 – Attach the AED Pads
- If needed, remove any clothing or under garments covering the victim’s chest. These items will interfere with the performance of the AED.
- Retrieve the AED pads. Some AEDs provide adult and child pads. Choose the adult pads for adults and children aged 8 years and older. Never use child pads in this case, because they are not large enough to deliver an effective shock.
- Peel the backing away from each pad and place the adhesive portion tightly on the bare skin of the victim. Follow the placement instructions on the pads. The two most common placement options are anterolateral and anteroposterior.
-If needed, attach the pad cables to the AED. Most AEDs have pads that are already connected to the device.
or a two-person rescue, one rescuer should set up the AED while the other rescuer provides chest compressions.

Step 3 – Allow the AED to Analyze the Heart Rhythm
- Some AEDs will prompt the operator to push a button to start analyzing the heart rhythm, while others will do so automatically. Regardless, when an analysis starts, no one should touch the victim. If anyone is touching the victim, a faulty analysis may occur.
- If multiple rescuers are present when the AED prompts that an analysis is starting, the AED operator should loudly give a “clear victim” message, such as “stand clear” or simply “clear”. All rescuers should use closed-loop communication to indicate that they are clear of the victim by responding with “clear” and holding their hands up.


Step 4 – Deliver a Shock, if Advised by the AED
- If the rhythm is shockable, the AED will prompt to shock the victim. When this occurs, compressions should stop, and no one should touch the victim. If anyone is touching the victim, they could be injured when the shock is given.
- If multiple rescuers are present when the AED prompts to shock the victim, the AED operator should loudly give a “clear victim” message. Again, all rescuers should use closed-loop communication to indicate that they are clear of the victim by responding with “clear” and holding their hands up.
- The AED operator should make sure everyone is clear and then press the shock button on the AED. The shock will create a sudden contraction of the victim’s muscles.

Step 5 – Immediately Restart Chest Compressions
-Once the shock has been delivered, or if no shock was recommended, CPR should be restarted immediately with chest compressions.
-In general, CPR and, specifically, chest compressions should be performed whenever the AED is NOT analyzing the heart rhythm or delivering a shock.


Step 6 – Repeat Rhythm Analysis when Prompted by the AED
After about 2 minutes, or 5 CPR cycles, the AED will prompt the rescuers to perform another heart rhythm analysis, thus repeating the previous steps. replay
This sequence of CPR and AED usage should continue until:
- The victim shows signs of ROSC, such as coughing, normal breathing, or movement.
- Care is transferred to an advanced life support team.
- The rescuers are unable to continue because of exhaustion, or the scene becomes unsafe.
- A valid document stating that resuscitation should be stopped is presented.

Special Conditions
Special conditions may require the rescuer to take additional action when placing AED pads on a victim. These include victims with:
- Hairy chests
- Pacemakers or implanted defibrillators
- Transdermal medical patches
- Water covering the chest
- Flammable material nearby
The rescuer should observe for these conditions and take appropriate action.
Special conditions that do NOT require additional actions are pregnancy, a victim on a metal surface, and jewelry or body piercings. In the case of jewelry or body piercings, these items do not need to be removed. However, avoid placing the AED pads directly over any metallic items.

Hair on Chest
Chest hair rarely interferes with pad placement. However, excessive amounts of hair on the chest can prevent good pad contact. If this is the case, the hair should be very quickly removed where the pads need to be placed. This can be done by shaving the hair – razors are included with some AEDs. If shaving material is not available, an extra pair of pads or child pads can be firmly put in place and quickly pulled off to remove the hair.

Pacemakers or Implanted Defibrillators
A victim may have a pacemaker or implanted defibrillator. These devices can interfere with the delivery of an AED shock. They can be identified because they create a hard-lump underneath the skin.
Before placing the pad on the skin, look and feel for any hard lumps. If a hard lump is detected, try to avoid placing the pad on top of the lump.

Transdermal Medical Patches
Transdermal medical patches are patches on the surface of the skin. These patches can interfere with the delivery of an AED shock and may also cause a small burn.
If it can be done quickly, remove the patch and wipe the area before applying the pad. Otherwise, avoid placing the pad over the patch.

Water Covering the Chest
Water will conduct the shock away from the path that it needs to take. If the victim is in water, quickly pull them out of the water. If their chest is covered in water, quickly wipe the chest before attaching the AED pads. Avoid getting the AED or AED pads wet.
If the victim is on snow, or in a small puddle, they do not need to be moved.
Flammable Material Nearby
Do not use an AED around flammable liquids or combustible materials, such as gasoline or free-flowing oxygen.

AED Maintenance
As with any device, routine maintenance of the AED is important to ensure it is in good working order and ready to use when needed. AEDs require very little maintenance, but it is important to regularly check them according to the manufacturer’s instructions or local protocols. Maintenance may include changing batteries, calibrating the device, and ordering and replacing supplies such as pads, scissors, razors and wipes.