AED training

[Foxbat]

I have heard two types of directions for AED use:

a) only attach it after verifying that patient is pulseless to avoid delivering inappropriate shocks which can kill the patient;

b) when see unresponsive person, attach it; the machine is smart enough to know when not to shock.

First approach it from my EMT-B book; second approach I heard a couple times when public was instructed in AED use.
So, if my Basic book is correct, why do they teach second approach to public? Is the risk of layperson being unable to find carotid pulse higher than risk of AED shocking patient with pulse?

 

[IcantThinkofAname]

We were taught that it's important to check for pulse, etc. and also to do one round of chest compressions to "prime" the heart. However, if you see someone go down, rather than arrive after they're down, then we can use the AED immediately. I hope I'm recalling that correctly. But I definitely remember our teacher saying that the heart has to be "primed" for shocking so it's best to do compressions first.

I look forward to seeing answers from people with some experience, as I'm just a student at this point!

 

[ffemt8978]

The AHA and other organizations have really tried to simplify CPR/AED usage for the lay rescuer, which is why they apply the AED to an unresponsive person. In addition, they've removed the pulse checks from the lay rescuer courses because of gross inaccuracies (finding pulse when there wasn't one or not finding a pulse when there was one.)

As EMS, we're held to different standards which is why we verify pulselessness before attaching.

 

[imurphy]

There are 2 different types of AEDs. And at this point I'm only talking about the "shock boxes" not including the Lifepak 12 or the likes as they, even thought they function as AEDs, I don't consider them as AEDs they're monitor/defibrillators.

PAD (Public Access Defibrillation) use the (f)AEDs (Fully Automatic External Defibrillators) like the Lifepak CR Plus don't require you to push a shock button. Simplicity itself, you open the cover, which turns on the AED, put on the pads (I can't remember the model, but on one it has a picture of the body with 2 LEDs at the mid-clavicle and mid-auxiliary placement points which light green with good placement) and the machine takes over. The reason behind this is a lay rescuer may not be able to palpate a pulse correctly, and may think there is a pulse when there isn't and not put on the fAED. So they are told to put the fAED on any unresponsive casualty. The rational is that the machine won't shock anyway, so it can only do good.

Conversely, BLS units carry sAED's or Semi-Automatic External Defibrillators. The reason the EMTs are told to check for a pulse is, well they SHOULD be able to find one! So they have the emergency training to use the aAED correctly and not need to put it on all unresponsive persons as they know it can be many other reasons behind the unresponsiveness apart from VF/VT.

Hope this explained it better!

 

[rhan101277]

We were taught that it's important to check for pulse, etc. and also to do one round of chest compressions to "prime" the heart. However, if you see someone go down, rather than arrive after they're down, then we can use the AED immediately. I hope I'm recalling that correctly. But I definitely remember our teacher saying that the heart has to be "primed" for shocking so it's best to do compressions first.

I look forward to seeing answers from people with some experience, as I'm just a student at this point!

If you have a AED handy I don't think you have to prime. I asked my instructor about this and he said use the AED, when it the book it says prime even though you have it handy.

 

[reaper]

If it is a witnesed arrest, Go straight to the AED. If they have been down a while, then do 2 minutes of compressions prior to the AED.

 

[imurphy]

Train of thought on priming the heart before AEDing, is, even in a witnessed arrested, the Inter Aerial Pressure has gone to s**t (BP 0/0 ) so the rationale is if the pump has no pressure it's better to start it with a bit of pressure already in it. It moves for a better outcome! Both for you and the patient. Life for them, no M&M for you! 

This is why I think the EMTs being trained should not only be told what to do but WHY to do it. When I did my training, I was never told why, just how. It was only when I did my BLS Instructor course that I got the why!

Note to new EMTs. When given a how, ask for a why. You'll understand better and be a much better EMT!

 

[MagicTyler]

This is why I think the EMTs being trained should not only be told what to do but WHY to do it.

If you went over every why in an emt class, you'd be in school for 6 years and pretty much be a doc.....

 

[JPINFV]

If you went over every why in an emt class, you'd be in school for 6 years and pretty much be a doc.....

No, especially at the EMT-B level, you'd be in school for about a year longer since a good anatomy and physiology series and biochemistry course would clue you in for a lot of the whys. It really doesn't take that long for someone to know why oxygen is needed or how it's transported throughout the body.

 

[TransportJockey]

If you went over every why in an emt class, you'd be in school for 6 years and pretty much be a doc.....

And thats a bad thing? We've already established that the EMT-B course is much too short and lacking on info

 

[imurphy]

If you went over every why in an emt class, you'd be in school for 6 years and pretty much be a doc.....

Then it's kinda what do you want to be? A mechanical EMT who just does what protocols say and never ask why or an informed EMT who knows what to do, but knows the reasons too.

I agree with jtpaintball70. When I did my EMT, after every class I went home and checked out the internet and found out the whys. Still finished it in the same time and know a lot more which helps me, and my patients!

 

[Ridryder911]

If you went over every why in an emt class, you'd be in school for 6 years and pretty much be a doc.....

Let's not confuse knowing and understanding what to do. Basic EMT is written at the 6'th grade level so even comparing the course to a mid level is wrong. One can educated at an abbreviated level and still be taught properly. Not knowing is inexcusable.

R/r 911

 

[traumateam1]

(Coarse V-Fib)
VS

(Fine V-Fib)

That is why we shock right off the bat if witnessed, and "prime" if we respond or don't witness the arrest.

As we all know the AED has a much higher success chance if shocked either right away in the case of witnessed, or after 2 minutes of CPR in the case of a non witnessed arrest.

 

[imurphy]

Don't forget:

SVT (Pulseless)

In the case before the Para's get there to Cardiovert! Althought with the shock box you wont know what rhythm they're in anyway!

 

[mycrofft]

I hate EMD....

OK EKG, no pulse.
Go to the textbook and your local standard.

 

[Ridryder911]

It is very rare to find a sinus PEA (EMD for us old timers). Again the problem is PEA is a syndrome not a rhythm, and the cause has to be eliminated before successful treatment occurs hence the problem.

R/r 911

 

[mycrofft]

Yeah, only saw one that i know of, long ago, before AED's...

Paramedics had no tx algorithm for that. Massive
tic tac to on the ventricular myocardium. And he had slathered his chest in hydrocortisone cream just before he went, so getting leads to stick wasn't much fun.

 

[Outbac1]

No, especially at the EMT-B level, you'd be in school for about a year longer...

Hmmmmm starting to sound like our PCP program. Seven months of 40 hr weeks and three months of clinicals and ride time.

 

[Jon]

Ok.

The AHA has removed the pulse check from layperson CPR - it is simply a "check for responsiveness" and you give CPR if they aren't breathing. Healthcare providers are the only ones trained in a pulse check.

Studies show that pulse checks don't work... it takes lots of practice and even HCP's get it wrong. http://www.scienceblog.com/community/older/2000/A/200000488.html

As for semi auto AED's vs. automatic AED's... some require you to press a button to shock, some don't. Not all public access AED's are fully automatic, and EMS agencies occasionally have fully automatic AED's.


AED's WILL ONLY shock 2 rhythms. Ventricular Fibrillation and Ventricular Tachycardia. V-Fib is going to ALWAYS be without a pulse. V-Tach might present with a pulse. If they have a pulse, but are unstable, an ALS provider would try to cardiovert them. If this isn't done fast, the patient is going to go into arrest anyway.

The option is the compromise that the student will remember in a year or two.