AED Pads for Conscious Patients?

[RedAirplane]

I was talking to a friend who recently ran a CP call.

He turned on the AED and put the pads on, with the logic that if the pt went into VT he would want to shock before the pt lost consciousness.

I was surprised because we're told specifically not to do that in EMT class. But upon talking to other people, it seems that many people do that for CP calls and it is somewhat accepted.

What are your thoughts?

 

[Flying]

Not all chest pains are MIs. It's also a bit rich to be anticipating VF/VT without an ECG.
Also, does not your service consider the cost of pads?

I think it's flipping stupid.

 

[ERDoc]

This sounds like someone is looking to justify using a toy that is not needed or appropriate or trying to make it look like they are a higher level than they are.

 

[EMSComeLately]

The following assumes your friend is an EMT. There are too many CP etiologies to throw on pads immediately. It's not like you can use an AED for a synchronized cardioversion for VT with a pulse. And, it'd still take time to get the AED to analyze once someone goes pulseless. Your friend should focus on BLS practice and CAB along with AED at that time.

And if they weren't helping patient administer their own aspirin and nitro (all assumptions about patient confirmed) they also skipped other more important priorities over the AED.

 

[chaz90]

Yeah, I really don't see the sense in that. As an ALS provider, I put the pads on conscious STEMI patients and those with confirmed/deteriorating cardiac rhythms after I do an EKG.

 

[ERDoc]

I'm curious if this provider removes the pad before taking the pt out of the ambulance and into the ER.

 

[Ewok Jerky]

It's a reasonable move on an unstable patient, but not high on my list of priorities when there are lines to start, meds to give, reports to call in and such...talking about monitor pads not an aed though.

 

[Tigger]

No.

It's reasonable to place defib patches on the patient once the monitor shows something scary. But as an EMT with an AED, you can't see that and are just wasting expensive pads.

 

[RedAirplane]

The following assumes your friend is an EMT. There are too many CP etiologies to throw on pads immediately. It's not like you can use an AED for a synchronized cardioversion for VT with a pulse. And, it'd still take time to get the AED to analyze once someone goes pulseless. Your friend should focus on BLS practice and CAB along with AED at that time.

And if they weren't helping patient administer their own aspirin and nitro (all assumptions about patient confirmed) they also skipped other more important priorities over the AED.

They administered 325 mg ASA chewed and oxygen for a low SpO2, as well as controlled for shock with a space blanket given the cold/wet weather they were in.
After that they used the AED pads.

It's not often that we get this type of call so neither myself nor our leadership was concerned with the waste of the pads-- my big question was medical validity.

Can an AED distinguish VT with a pulse and pulseless VT? If it can, then it makes no sense to use the pads since it won't shock the pt while s/he has a pulse. If it cannot, then I might see some use with an unstable patient (SVT or something), but I'd be well out of my comfort zone to try some stunt like that, so I probably wouldn't.

 

[EMSComeLately]

They administered 325 mg ASA chewed and oxygen for a low SpO2, as well as controlled for shock with a space blanket given the cold/wet weather they were in.
After that they used the AED pads.

It's not often that we get this type of call so neither myself nor our leadership was concerned with the waste of the pads-- my big question was medical validity.

Can an AED distinguish VT with a pulse and pulseless VT? If it can, then it makes no sense to use the pads since it won't shock the pt while s/he has a pulse. If it cannot, then I might see some use with an unstable patient (SVT or something), but I'd be well out of my comfort zone to try some stunt like that, so I probably wouldn't.

The AED is only there to analyze for unsychronized shockable rhythms, i.e., pulseless vf/vt.

It's good to hear that other priorities were covered first.

 

[TransportJockey]

They administered 325 mg ASA chewed and oxygen for a low SpO2, as well as controlled for shock with a space blanket given the cold/wet weather they were in.
After that they used the AED pads.

It's not often that we get this type of call so neither myself nor our leadership was concerned with the waste of the pads-- my big question was medical validity.

Can an AED distinguish VT with a pulse and pulseless VT? If it can, then it makes no sense to use the pads since it won't shock the pt while s/he has a pulse. If it cannot, then I might see some use with an unstable patient (SVT or something), but I'd be well out of my comfort zone to try some stunt like that, so I probably wouldn't.

If an AED read VT, it doesn't care if it has a pulse or not. It'll still say shock advised.

 

[EMSComeLately]

If an AED read VT, it doesn't care if it has a pulse or not. It'll still say shock advised.

True..it only knows electrical, but not mechanical pulse...an obvious but easy to forget point.

 

[LACoGurneyjockey]

They administered 325 mg ASA chewed and oxygen for a low SpO2, as well as controlled for shock with a space blanket given the cold/wet weather they were in.
After that they used the AED pads.

It's not often that we get this type of call so neither myself nor our leadership was concerned with the waste of the pads-- my big question was medical validity.

Can an AED distinguish VT with a pulse and pulseless VT? If it can, then it makes no sense to use the pads since it won't shock the pt while s/he has a pulse. If it cannot, then I might see some use with an unstable patient (SVT or something), but I'd be well out of my comfort zone to try some stunt like that, so I probably wouldn't.

Whether you can or not, DO NOT TRY AND USE AN AED TO DEFIB A PATIENT WITH A PULSE (SVT, VT w/ a pulse, CP/MI). You have an AED for pulseless patients. An unsynchronized cardioversion (defibrillation) of V Tach with a pulse can very well send your patient into cardiac arrest. That's bad.
I remember a horror story of bystanders applying an AED to a patient who collapsed. He then had a seizure, and the AED detected VF and shocked him... 3 times. They're not fool proof. You, as an EMT, need to not only be smarter than the machine, but know when to use it and when not to.

 

[redundantbassist]

He turned on the AED and put the pads on, with the logic that if the pt went into VT he would want to shock before the pt lost consciousness.

Wait.. did this guy seriously suggest performing an unsynchronised cardioversion on a fully concious, unseated patient with an AED? I would be very wary of this employee and would keep a close eye on him during calls.

I was surprised because we're told specifically not to do that in EMT class.

Even so, if someone is so stupid and lacking in common sense that they need this to be specified to them, they should not be working with patients.

 

[Tigger]

Can an AED distinguish VT with a pulse and pulseless VT? If it can, then it makes no sense to use the pads since it won't shock the pt while s/he has a pulse. If it cannot, then I might see some use with an unstable patient (SVT or something), but I'd be well out of my comfort zone to try some stunt like that, so I probably wouldn't.

Use AEDs for what they are for. Do not make things more difficult.

 

[EpiEMS]

For fun: http://gatheringofeagles.us/2013/Saturday/Gallagher-AEDCaseReport.pdf
A little gathering of eagles case presentation for you all.

More on topic, though, applying AED pads to a conscious well perfused patient is more likely than not contraindicated.

 

[Eddie263]

If you weren't trained to do something, don't do it. Theres a reason cardioversion is an ALS skill. Not only does it require a shock but meds as well.

 

[NomadicMedic]

I remember a horror story of bystanders applying an AED to a patient who collapsed. He then had a seizure, and the AED detected VF and shocked him... 3 times. They're not fool proof. You, as an EMT, need to not only be smarter than the machine, but know when to use it and when not to.

That sounds like urban legend to me. There is no way an AED will recognize a simple seizure as VF in a patient with a normal QRS and shock a patient three times. Not gonna happen.

 

[Gurby]

Wait.. did this guy seriously suggest performing an unsynchronised cardioversion on a fully concious, unseated patient with an AED? I would be very wary of this employee and would keep a close eye on him during calls.

Somewhat related...

I saw this in the hospital during my medic clinical time, though with an actual monitor not an AED. Guy comes in having an MI. They do a 12 lead, throw the pads on, and while everyone is standing around talking he goes into VF. Somebody notices it and is like hey VF! Shock. Guy comes to, he's like ow that hurt. VF again! "Sorry buddy"... Zap! Guy comes to again, is not appreciating our efforts. He probably went into VF and then got shocked out of it 5 times and was more or less conscious the entire time, before they got some amiodarone in him and shipped him off to the cath lab. Pretty sure he had a good outcome when all was said and done, but he was pretty lucky to have coded in the ED and not 10 minutes earlier in the back of the BLS ambulance that brought him in.

 

[LACoGurneyjockey]

That sounds like urban legend to me. There is no way an AED will recognize a simple seizure as VF in a patient with a normal QRS and shock a patient three times. Not gonna happen.

Not an urban legend, a call that the other crew in my station ran. After talking with the ER doc, his conclusion was based on the labs there was no way he could have arrested. Several bystanders on scene reported shocking 3 times with the AED. Take it or leave it, but it's not some war story I heard in EMT class.