AED's and its use

[emt123]

In EMT-B class, we are taught to use an AED on breathless, pulseless individuals no matter what. Some paramedics on the other hand seem to rarely use them. What are y'alls protocols regarding AED's, just for insight. I work in healthcare (intensive care), and i was told that only specific rhythms should a Defib machine be used (V-tach and V-fib). Why is it one way or the other? I understand that in the field (EMT) your most likely on your own initially, and that is the best thing you can use along with CPR and Airway management.

[jw-c152]

emt123,

I believe your question is a matter of symmantics.

You are correct that only patients in pulseless Ventricular Tachycardia and Ventricular Fibrillation should be defibrillated.

However, I believe your confusion is over the function of an Automated External Defibrillator (AED).

When you use an AED it is not your job to interpret the patient's cardiac rhythm. You do not need to know if the patient is in V-Tach or VF (in fact, most AED's won't even show you the rhythm) because the AED interprets the rhythm and determines if the patient should be shocked. Yay for technology.

When told by your EMT-B class that you should "use the AED on all breathless, pulseless individuals" what they meant is that you should APPLY the AED to all of these patients. The AED will then decide whether or not to shock. It will not let you deliver a shock if the patient is not in VF or VT.

So yes, only VF and VT should be shocked, but as an EMT-B or any other member of the public using an AED you do not need to determine if you should shock or not. Apply the AED, follow the instructions on the front of it and all will be well... Except perhaps the dead guy.

Hope that helps a bit.

Later.

[medic001918]

emt123,

I believe your question is a matter of symmantics.

You are correct that only patients in pulseless Ventricular Tachycardia and Ventricular Fibrillation should be defibrillated.

However, I believe your confusion is over the function of an Automated External Defibrillator (AED).

When you use an AED it is not your job to interpret the patient's cardiac rhythm. You do not need to know if the patient is in V-Tach or VF (in fact, most AED's won't even show you the rhythm) because the AED interprets the rhythm and determines if the patient should be shocked. Yay for technology.

When told by your EMT-B class that you should "use the AED on all breathless, pulseless individuals" what they meant is that you should APPLY the AED to all of these patients. The AED will then decide whether or not to shock. It will not let you deliver a shock if the patient is not in VF or VT.

So yes, only VF and VT should be shocked, but as an EMT-B or any other member of the public using an AED you do not need to determine if you should shock or not. Apply the AED, follow the instructions on the front of it and all will be well... Except perhaps the dead guy.

Hope that helps a bit.

Later.

+1 for a well written post. The only thing I can add in regard to the paramedics not using an AED frequently is that we are trained to use a manual defib and to interpret the EKG on our own. Commonly, our monitor/defib is capable of far more then just defib as we can visualize the rythem, pace, cardiovert, control the energy for the shock, etc. That's why you will rarely see a paramedic using an AED as opposed to a standard cardiac monitor.

Shane

NREMT-P

[AZCEP]

Careful with the reliance on the technology gents.

I have been witness to several instances where the AED would "interpret" the patient's rhythm to be VF/VT and it wasn't. I know this because I had my manual defibrillator applied after the BLS personnel had their AED attached.

AED's will deliver shocks to tachycardias, as well as ventricular rhythms. Tachycardias being over 130 beats/minute in most AED's algorithm, and ventricular rhythms being complexes wider than 0.14 sec. Good compressions are frequently misidentified by AED's as shockable. It is also possible for the AED to "identify" a shockable rhythm immediately following the stop of compressions.

If the patient has no pulse, there is very little danger of making the situation worse with an AED. Just understand what the device is/is not capable of doing.

[Pimamedic]

As I remember my AED training there shuld be no compressions happenign when the AED is analyzing the patients rhythm. In fact no one should be touching the patient.

[medic001918]

As I remember my AED training there shuld be no compressions happenign when the AED is analyzing the patients rhythm. In fact no one should be touching the patient.

You are correct. Movement of the patient will create a waveform that could be misinterpreted.

Shane

NREMT-P

[n5iln]

I have been witness to several instances where the AED would "interpret" the patient's rhythm to be VF/VT and it wasn't. I know this because I had my manual defibrillator applied after the BLS personnel had their AED attached.

AED's will deliver shocks to tachycardias, as well as ventricular rhythms. Tachycardias being over 130 beats/minute in most AED's algorithm, and ventricular rhythms being complexes wider than 0.14 sec. Good compressions are frequently misidentified by AED's as shockable. It is also possible for the AED to "identify" a shockable rhythm immediately following the stop of compressions.

If the patient has no pulse, there is very little danger of making the situation worse with an AED. Just understand what the device is/is not capable of doing.

Interesting sidenote...most AEDs (including the one I used last, the Lifepak 500) will shock one other rhythm other than VT and VF. And it's one I've only seen in textbooks. "What rhythm is that?", I hear someone in the back wonder out loud. It's...

...wait for it...

...Torsades de Pointes.

Just a little tidbit from the BEMT-D, former monitor tech and general collector of odd EMS trivia...