safe AED usage on a drowning victim?

[paramedichopeful]

Hey guys. This is the first time I've been on here in awhile (ok, months), and I need a bit of help. I am getting ready to go into the EMT-I phase of my class and we are starting with advanced AED tomorrow. Yesterday my instructor gave me a challenge: create detailed, illustrated flashcards for using and AED. It was very simple and easy, until I got to the section on using an AED on a pt. that has been pulled from the water. So, I have a few questions. What are some tips to keep from getting electrocuted? Is there any special placement of teh pads? Any other special procedures? I couldn't really find much online, but it has to be different procedure because common sense is telling me that h20 and 300 joules don't mix that well. I'd appreciate any help. Thanks!

 

[Shishkabob]

Dry off the pt and don't touch water.



Nothing else to it.

 

[MMiz]

I posted a thread about this a few years ago. I learned that you pat the patient dry and stay clear of any standing water.

 

[Lifeguards For Life]

just make sure you and your patient are not in a pool of water.

Once you dry the patient off, they are no longer wet, so procceed as normal

 

[Micro_87]

+4 just make sure they're dry and your not around water.

 

[foxfire]

just make sure you and your patient are not in a pool of water.

Once you dry the patient off, they are no longer wet, so procceed as normal

agreed.
One way we were taught, is to make use of the back board that the pt is already on and move the them out of the puddle. because the pt is going to make one just coming out of the water. And have a few towels on hand to mop up any stray water.
like from the lifeguard who is dripping wet while doing cpr.
sidenote: they are not actualy strapped to the board just on it.

 

[medichopeful]

Dry the patient, and try not to have them lay in a pool of water. The placement of the pads should be the same: lower left and upper right.

Also, make sure to remove any chains, necklaces, nicotine patches, etc. Do it like you always would with an AED, just make sure to dry the patient and don't touch water.

Hope this helps!

 

[Tyler Bruns]

Sounds like everyone else has your answer covered but I thought I would throw this out there. My teacher uses the mnemonic PANDA for AED indications.
P- Pulse less
A- Apniec
N- Non-traumatic
D- Dry
A - All ages
Obviously the dry part pertains to this question.
Hope it helps.

 

[trevor1189]

Also, make sure to remove any chains, necklaces, nicotine patches, etc. Do it like you always would with an AED, just make sure to dry the patient and don't touch water.

I don't think I have ever been told to remove chains, necklaces, nicotine patches. Do you have a reason for doing this? I can understand if something is in the way where you need to place the pad, but otherwise what's the point?

 

[medichopeful]

I don't think I have ever been told to remove chains, necklaces, nicotine patches. Do you have a reason for doing this? I can understand if something is in the way where you need to place the pad, but otherwise what's the point?

It's just to get rid of any possible interference. If it's a metal necklace, you can see why (it's a good conductor). If it's a different type of necklace, you may be able to leave it on, but I personally would cut it off. Better to be safe than sorry.

As far as medication patches go, I should have been more clear. You only need to take those off if they will interfere with the AED pads.

Hope that helps!

 

[EMSLaw]

Yeah, ditto what everyone else said. Dry them off, and don't stand in the puddle. This time of year, you're probably going to want to get them out of those wet clothes anyway.

Actually, that's sort of an interesting scenario. Victim in the water, in winter. Obviously, you have to dry them off. Would you move them to the rig for passive rewarming and start CPR in the back of the (non-moving) ambulance, or would you apply the AED and do some period of CPR on the cold, cold ground?

 

[foxfire]

Yeah, ditto what everyone else said. Dry them off, and don't stand in the puddle. This time of year, you're probably going to want to get them out of those wet clothes anyway.

Actually, that's sort of an interesting scenario. Victim in the water, in winter. Obviously, you have to dry them off. Would you move them to the rig for passive rewarming and start CPR in the back of the (non-moving) ambulance, or would you apply the AED and do some period of CPR on the cold, cold ground?

Hypothermia causes bradycardia, so I am thinking that staying out in the cold would not be a good idea.
Staying in the cold would be counter productive to the efforts of restarting the heart.

 

[paramedichopeful]

Thanks, guys. This should be the last piece of info I need to get these darn cards finished. Basic class was a cakewalk, but now things are getting a little harder. Just wish I could skip the rest of Intermediate and go right to IV's. Treatment of simple, almost nonexistent injuries is very much common sense, but still they feel the need to go over it 500 times. Should be very exciting when we get to doing airways and tubes. That's a long ways off though.

 

[Shishkabob]

Hypothermia causes bradycardia, so I am thinking that staying out in the cold would not be a good idea.
Staying in the cold would be counter productive to the efforts of restarting the heart.

Please Google "therapeutic hypothermia". One of the 'new' protocols going around is to actively cool cardiac arrest pts because it provide a better survival rate.

 

[Mountain Res-Q]

Come on people, you DO NOT use an AED on a drowning victim... haven't you ever read the label on the side of newer models? "Not To Be Used As a Flotation Device!" ^_^

Seriously, ditto all... and add to it that the same principles apply in Snow Conditions such as at a Ski/Snow Resort, in which scenerio the patient isn't just wet and moist, but actually lying in a field of water (frozen of course and with clothing already providing something of a barrier to the snow). In this case, you do your best to remove them the water (snow) and then remove as much moisture from the patient as 3-5 seconds will allow.

 

[foxfire]

Please Google "therapeutic hypothermia". One of the 'new' protocols going around is to actively cool cardiac arrest pts because it provide a better survival rate.

I think I remember hearing about it.
Is the "new" protocal for ALS or BLS?
From what I read it is still undecided as to the survival rate being better.
They stated that PEA, astolye, and a few other rythms had a lower survival rate than the noncooled group.
Please correct me if I am reading things wrong.

 

[Shishkabob]

Many systems wont let you terminate care on a hypothermic pt, because they show a better survival rate. As the old adage goes, "you're not dead until you're warm and dead".

Then there's Theraputic hypothermia, which tends to be after ROSC.



As far as ACLS, below a certain temp, you forgo normal ACLS algorithms, only do 1 shock, and don't do any drugs. Just straight up CPR.

 

[Scout]

I have a question, Will an AED shock you if your in a puddle with a Pt, assume pt chest has been dried and pads placed as per instruction.

 

[medichopeful]

I have a question, Will an AED shock you if your in a puddle with a Pt, assume pt chest has been dried and pads placed as per instruction.

I'm not sure, but why take the risk?

 

[medichopeful]

Read This

Here's an informational article on AED usage. It should answer any questions anybody has.

http://www.redcross.org/www-files/Documents/pdf/Preparedness/AED_FAQs.pdf