AED Pads for Conscious Patients?

RedAirplane

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That's reasonable. I'd rather have the BLS do the other regular BLS stuff in that scenario though and have a good report ready for whenever they do get ALS, and then the medics can decide whether to put the pads on or not if they need to provide some sort of electrical therapy.
This is a bit of a game of telephone, because I'm recounting something I heard that happened and was curious about it.

For the bottom line, if you assume that AED pads are a dime a dozen and that this wouldn't happen UNTIL an assessment, ASA, vitals, etc were done, would you ever want a BLS provider to do this? Conversely, is it just useless, or is it harmful?
 

chaz90

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This is a bit of a game of telephone, because I'm recounting something I heard that happened and was curious about it.

For the bottom line, if you assume that AED pads are a dime a dozen and that this wouldn't happen UNTIL an assessment, ASA, vitals, etc were done, would you ever want a BLS provider to do this? Conversely, is it just useless, or is it harmful?
I don't think it's actually harmful in any way, but still a wholly unindicated intervention.

If we're talking about a completely non-harmful but not indicated intervention, I could perform 12 lead EKGs 3x a day on my dad. He has no personal history of heart disease, is relatively healthy, and isn't complaining of anything. On the other hand, he's in his late 50s, slightly hypertensive, has some family history of cardiac problems, some MIs don't present with typical symptoms, and maybe I would someday catch some early pre-acute signs of ischemia and allow prompt and helpful intervention. The number needed to treat for the possible benefits of this therapy though is so tiny as to make it unreasonable, so no one would dream of doing this. Same applies towards placing AED pads on all chest pain patients. In the absence of any other diagnostic criteria, the number of "chest pain" patients who will arrest to a shockable rhythm in the presence of the BLS crew is so small as to make this unreasonable.
 

SixEightWhiskey

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Exactly! it's not indicated for the scenario presented. It's that simple. Also, the OP said something alone the lines of "so they can be shocked before they lose consciousness" as a reason. Typically if someone goes into VT/VF arrest, they're going to lose consciousness because they have just died! And even if they get an AED defibrillation and their heart starts beating again, they may very well remain unconscious.

Again, an AED is indicated for someone who is unresponsive, apneic and pulseless. Throwing it on everybody who has a chest pain/cardiac complaint is an incredible amount of overkill and is unwarranted.
 

RedAirplane

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Exactly! it's not indicated for the scenario presented. It's that simple. Also, the OP said something alone the lines of "so they can be shocked before they lose consciousness" as a reason. Typically if someone goes into VT/VF arrest, they're going to lose consciousness because they have just died! And even if they get an AED defibrillation and their heart starts beating again, they may very well remain unconscious.

Again, an AED is indicated for someone who is unresponsive, apneic and pulseless. Throwing it on everybody who has a chest pain/cardiac complaint is an incredible amount of overkill and is unwarranted.
The exact logic of my colleague was to address a pulse-producing VT (such as SVT).
 

chaz90

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The exact logic of my colleague was to address a pulse-producing VT (such as SVT).
Yikes. Even worse.

SVT (supraventricular tachycardia) is by definition a category of tachycardias originating above the ventricles and thereby excluding VT.

Cardioversion with proper sync is not possible on an AED. Cardioversion is explicitly not a BLS or layperson skill, and your friend could face legal charges if he knowingly performed this and the patient had a poor outcome...I'd tell him to avoid this at all costs and not even consider it.
 

Flying

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The exact logic of my colleague was to address a pulse-producing VT (such as SVT).
Tell your bud to stop practicing medicine without a license.

I can also get really excited about doing more with the few tools given, but come on.
 

ERDoc

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We should probably prophylactically intubate all of our pts since, you know, they could all stop breathing too.
 

Jim37F

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We should probably prophylactically intubate all of our pts since, you know, they could all stop breathing too.
I was just about to say put a traction splint on everyone with a slip and fall or fender bender
 

RedAirplane

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I'll take ownership of the SVT bit. He said VT with a pulse, and I'm the idiot who thought that meant SVT.
 

CALEMT

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I was just about to say put a traction splint on everyone with a slip and fall or fender bender
I was going to say full c spine but most of EMS already does that.
 

DPM

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Outside of pacing, I've put pads on a chest pain PT once in the absence of STEMI. In that case the PT was borderline bradycardic (rate ~ 65), looked terrible, though no MI on the monitor, and I was pleasantly surprised that he didn't code. I thought I would pacing before pretty soon, but the PT was an EMR Ski patroller, and I think the adrenalin burst from me putting the pads on is what got his heart rate up.
 

DrParasite

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Unless you're @DrParasite and believe that the best treatment is simply "throw 'em in a BLS truck and take 'em to the hospital"
I never said that, nor would I, but nice try. better luck next time.
 
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