Defibrillation Safety

  1. Environmental safety ..
    2 points
    • Do not use the defibrillator around flammable agents, oxygen rich atmospheres or anaesthetics.
    • Do not use the defibrillator on or near water or on metal surfaces
  2. Equipment ...
    3 points
    • Damaged therapy cables must be replaced
    • Do not use dry, damaged, faulty or expired defibrillation pads.
    • If the monitor displays the Stop symbol in the RFU indicator window, it indicates a monitor failure and it should be replaced.
  3. Chest preparation ...
    2 points
    • Wipe moist or sweaty skin with a dry towel only. Do not use Betadine or alcohol wipes as they can cause burns and interfere with pad adhesion.
    • Clip chest hair only when coarse, dense and wiry. Refrain from shaving as this can cause electrical arcing.
  4. Defibrillation Pad location considerations ...
    5 points
    • Do not place defibrillation pads over GTN patches, GTN paste, implanted pacemakers or ECG electrodes and/or cables.
    • Avoid skin pigmentations and nipples to prevent burns.
    • Avoid skin folds to prevent electrical arcing.
    • Do not allow contact between the defibrillation pads and/or ECG electrodes or cables.
    • Do not perform chest compressions over the defibrillation pads or wires (unless CPR feedback pads are in use).
  5. Defibrillation Pad Placement and Application ...
    2 points
    • The Apex pad is rolled on horizontally from the anterior aspect of the cardiac apex on the pt's left side, at the mid or anterior axillary line.
    • The Sternal pad is rolled on horizontally from tight sternal margin on the pt's right chest, under the right clavicle and above the right nipple.
  6. Defibrillation Pad Application Technique ...
    4 points
    • Apply the pad in a rolling motion to avoid air pockets.
    • Smooth the pad into the intercostal spaces of thinly built people.
    • Apply gentle pressure over the entire surface of the gel and adhesive ring to ensure adhesion.
    • Do not defibrillate if the defibrillation pads are not properly adhering to the pt.
  7. Operator Safety ..
    2 points
    • Just prior to analysing, charging and defibrillating call "stand Clear" and confirm "All Clear".
    • To confirm "All Clear", visually check no-one is touching the pt or equipment attached to the pt when analysing, charging or delivering a shock. Maintain visual contact with the pt.
  8. Defibrillation considerations ....
    1 point, 3 exceptions
    Do not defibrillate when there is any pt movement, stretcher movement or the ambulance is not stationery except when:

    •      pt suffers cardiac arrest during transport, where the process of safely parking the ambulance may cause a delay to defibrillation.
    •      Pts are being transported with mechanical CPR in progress and require regular defibrillation, where frequently stopping the ambulance will delay definitive care.
    •      Performing synchronised cardioversion (MICA only)
  9. Shock Advisory Mode (SAM) contraindications ..
    1 point
    Pts who are 11 years of age or less.
  10. Shock Advisory Mode (SAM) Defibrillation Considerations ...
    Defib regardless of SAM analysis (3 points)
    • The delivery of a defibrillation, regardless of the result of the SAM analysis should occur when: 
    • Unconscious, pulseless, VT is present at a rate of less than 150.
    • Motion or electrical artefact has affected SAM analysis, but the underlying rhythm as determined from the printout is VF or VT.
    • Pacing spikes have affected SAM analysis but the underlying rhythm determined from the printout is VF or VT. In this case when time permits and without interruption to CPR the 4 limb leads should be applied then return to SAM analysis.
  11. Weight/Age limit of paediatric defibrillation pads ....
    1 point
    Visually check manufacturer's instructions for weight.
  12. Paediactric Defibrillation pads application ...
    4 points
    • As close as possible to adult placement - ie anterior / anterior.
    • The "anterior" pad is placed on the left side anterior to the axillary line (same as adult placement).
    • The "posterior" pad on the right upper right chest / clavicle (same as adult placement).
    • Wrapping over the shoulder is permissible to ensure sufficient gap between the pads. Avoid the neck.
  13. Paediatric defibrillation ...
    2 x age range calculations & rounding up
    * Paediatric pt ages: 1-9 (Weight=Agex2+8)

          Example for a 4 year old:

    •       Calculate weight: 4x2+8=8+8+16kg
    •       4 Joules per kilo = 16kg x 4 joules = 64 joules
    •       ROUND UP to Zoll Energy Select Menu pre-set value which is 70 Joules

    * Paediatric pt ages: 10-11 (Weight=3.3xAge)

           Example for a 11 year old:

    •      Calculate weight: 3.3x11=36.3kg (36 kg)
    •      4 Joules per kg = 36kgx4 Joules = 144 Joules
    •      ROUND UP to the Zoll Energy Select Menu pre-set value with is 150 Joules.

    * If the calculated joules value falls between 2 pre-set joule options, you should ROUND UP to the next pre-set joule option.
  14. Zoll joule settings ...
    • Newborn: Weight=3.5kgs, DCCS=14, Zoll=15
    • 3mth: Weight=6kgs, DCCS=24, Zoll=30
    • 6mth: Weight=8kgs, DCCS=32, Zoll=50
    • 1yr: Weight=10kgs, DCCS=40, Zoll=50
    • 2yr: Weight=12kgs, DCCS=48, Zoll=50
    • 3yr: Weight=14kgs, DCCS=56, Zoll=70
    • 4yr: Weight=16kgs, DCCS=64, Zoll=70
    • 5yr: Weight=18kgs, DCCS=72, Zoll=85
    • 6yr: Weight=20kgs, DCCS=80, Zoll=85
    • 7yr: Weight=22kgs, DCCS=88, Zoll=100
    • 8yr: Weight=24kgs, DCCS=96, Zoll=100
    • 9yr: Weight=26kgs, DCCS=104, Zoll=120
    • 10yr: Weight=33kgs, DCCS=132, Zoll=150
    • 11yr: Weight=36kgs, DCCS=144, Zoll=150
    • 12yr: Weight=40kgs, DCCS=160, Zoll=200
    • 13yr: Weight=43kgs, DCCS=172, Zoll=200
    • 14yr: Weight=46kgs, DCCS=184, Zoll=200
  15. What 5 items on an ECG are assessed when determining the rhythm?
    • Ventricular Rate
    • Ventricular Rhythm
    • PR interval
    • P Waves
    • QRS duration
  16. What is the ECG rhythm criteria for VF?
    • Ventricular rate - undiscernable
    • Ventricular rhythm - nil
    • No associated P waves
    • No discernable PR interval
    • QRS no discernable
  17. What is the ECG rhythm criteria for VT
    • Ventricular rate >100
    • Ventricular rhythm - regular
    • No associated P waves
    • No PR interval
    • QRS wider than 0.12 secs
  18. What is the ECG criteria for Asystole?
    • Ventricular Rate - 0
    • Ventricular Rhythm - nil
    • No associated P waves
    • No PR interval
    • QRS - nil
  19. What is the ECG criteria for Sinus Rhythm?
    • Ventricular Rate - 60-100
    • Ventricular Rhythm - regular
    • P waves present and associated
    • PR interval 0.12 - 0.2 secs
    • QRS duration <0.12 secs
  20. What time value is one small square on the ECG paper?
    0.04 secs
  21. What time value is one large square on the ECG paper?
    0.2 seconds
Card Set
Defibrillation Safety
Defibrillation Safety