Automated External Defibrillator (AED)

An AED is a small, lightweight, and very portable electronic medical device that can analyze an unresponsive person's cardiac rhythm for the presence of a life-threatening arrhythmia. Pulseless ventricular tachycardia and/or ventricular fibrillation often occur in victims who collapse from sudden cardiac arrest. The chaotic, disorganized cardiac rhythms do not effectively pump blood and will often occur for several minutes following the collapse and loss of a palpable pulse. It is during this period that an AED can deliver a strategically placed electrical shock when a life-threatening cardiac dysrhythmia is present. The shock can convert an otherwise chaotic non-perfusing (not pumping blood) rhythm back to a "more normal" cardiac rhythm that can pump blood effectively.

Rapid defibrillation has proven to be the most effective treatment for victims of cardiac arrest when utilized within a couple minutes of collapse. AEDs have increased the survivability of sudden cardiac arrest in victims of all ages mainly due to community programs that strategically place AED units in public places where they are most needed. Most public AED stations will display a lighted sign similar to the one depicted in the picture below.

AEDs are now almost everywhere. Keep that in mind if faced with a sudden cardiac arrest victim in a public place, and ask someone to find one while you initiate care!

As soon as an AED arrives at the victim's side:

• First, turn the AED unit on.
  (Some newer units are automatic and will power-up as soon as the unit is opened.)
  
• Voice Prompt 1: "Remove clothing from the victim's chest."
• Voice Prompt 2: "Attach the appropriate pads to the victim's chest as shown."
  (The electrode pads will have highly visible diagrams to show where the pads should be placed on the specific victim.)
  

  
  The pad clearly marked "right" goes on the upper right aspect of the victims chest, while the pad marked "left" goes on the left side of the victims chest, just slightly lower than the right to ensure they do not touch.
  
• Voice Prompt 3: "Plug in the electrical connector."
  (Some newer models have cables that are permanently attached.)
• Voice Prompt 4: "Analyzing rhythm, everyone stand clear."
  (The AED is programmed to detect the presence of a pulse or no pulse; if no pulse is detected, the AED looks for one of the two shockable rhythms (pulseless ventricular tachycardia or ventricular fibrillation). If present, the AED will issue voice prompt 5.
  
• Voice Prompt 5: "Shock Advised! Everyone stand clear; push the shock button, now!"
  ( Make sure that no one is touching the victim just before pushing the defibrillation button.)
  
• Voice Prompt 6: "Begin five cycles of CPR."
  (Remember, new guidelines recommend chest compressions be delivered at 100 to 120 per minute in all age groups at 30 compressions to 2 rescue-breath cycles.)
  

  
• After two minutes of CPR, the AED will announce that it is re-analyzing the victim.
  (Remember to halt CPR and all victim contact during the analysis.)

AED Considerations and Precautions

• Adults with enough chest hair to prevent the pad from adhering completely to the skin should have their chest hair shaved in the immediate area to ensure good contact.
  (Most AED unit now have a disposable razor or two to shave the excess hair in this case.)
• If a razor isn't available and the victims chest is hairy enough to prevent the pads from sticking properly, you may have to improvise by using another means of hair removal.
  (Duct tape and/or electrode pads work well but make sure you have a second set before wasting the first set.)
• Ensure the victim's chest isn't wet before attaching pads, analyzing, or defibrillating.
  (Make sure to thoroughly dry the area where the pads will be placed.)
• If the victim was pulled from the water before the resuscitation effort and is wet, ensure their chest is completely dry before attempting to attach the defibrillation pads.
  (Make sure you are not standing in any water puddles when the victim is shocked.)
• If the victim has medication patches on their chest in the area where pads will be attached, such as nitroglycerin or nicotine, make sure you remove them and clean the area thoroughly. (Never use alcohol to clean the victim's chest when the possibility of defibrillation exists).
• When preparing to adhere the pads to the victim's chest, ensure you do not place the pads on top of obvious medical devices under the skin (e. g., a pacemaker). (Make sure you place the pads at least one inch from a pacemaker, implanted defibrillator, and/or electronic medication pump.)
• Pediatric pads deliver age-appropriate energy levels when defibrillating a child in cardiac arrest and should be used on children up to age 8 or 55 pounds. However, as of 2015, it is appropriate to use adult pads (therefore adult energy levels) on infants and children when age-appropriate pads are not readily available.
• Make sure that defibrillation pads never touch each other once they are attached to the victim. (If a pad is too large and likely to touch another, it is now appropriate to place one pad on their chest {right pad} and one pad {left pad} on their back.)

Congratulations!

You have completed the AED training material. If you are comfortable with this material, please proceed to the updates section. If you are unclear on any topics, please review them before proceeding to the next section.

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