Page 42 - Occupational Health & Safety, February 2018

DEFIBRILLATORS & CPR
AED and CPRCOverview and Implementation for Special Cases
BY SARAH GHERKE
ardiopulmonary resuscitation (CPR) is a ■ Determine patient status: breathing or not procedure used in emergency situations on breathing, level of consciousness, and pulse or signs of a person who has suffered cardiac arrest, circulation.
has nearly drowned, or is in a life-threat- Explain to the 911 operator or emergency op-
ening condition, possibly due to the progression of complications from an adverse health event. Use CPR when the patient has an undetectable heartbeat and is not breathing—include rescue breathing and chest compressions. Rescue breathing supplements oxygen to the lungs, and chest compressions circulate oxygen- ated blood to the vital organs and brain. The purpose of CPR is to artificially circulate blood to the patient’s brain and heart until medical professionals achieve the restoration of a normal heart and lung function with the aid of a cardiac defibrillator, medications, and other advanced medical interventions.
Automated External Defibrillators
More than a quarter million Americans die from sudden cardiac arrest every year—a death every two minutes. Patients in sudden cardiac arrest are nonre- sponsive and not breathing normally or at all. There may also be signs of poor to no circulation. More than 20,000 of those patients might be saved through the use of a “chain of survival,” including CPR and the portable lifesaving device known as an automated ex- ternal defibrillator (AED).
AEDs allow trained non-medical personnel to de- ploy usage upon the collapse of a person who is not breathing, is unconscious, and appears to be in sud- den cardiac arrest. If individuals are trained to use the AED as they are trained in CPR, broadly as first re- sponders, the American Heart Association notes that up to 50,000 people might be saved each year.
Automated external defibrillators work by detect- ing cardiac rhythm and are only indicated for and intended for use among victims of sudden cardiac ar- rest. Should normal rhythm be interrupted by abnor- mal heart rhythms such as ventricular fibrillation or pulseless ventricular tachycardia, the AED can deliver an electrical shock to treat the arrhythmia.
The Cardiac Arrest Survival Act of 2000 provides Good Samaritan protection exempting anyone from liability when using an AED to save someone’s life (42 U.S.C. 238q). These acts vary by state, but generally, they limit the liability of rescuers using AEDs and others involved in the AED program. Please read the Good Samaritan Act for your state for details.
AEDs are simple to use. If you are a trained re- sponder who finds someone unconscious and not breathing normally or not breathing at all, the proce- dure for use is simple:
■ Assess scene for hazards.
■ Call 911 or activate the emergency response team.
■
erator that a person has collapsed. Tell the operator that an AED is there and that you know how to use it. ■ Place the AED next to the collapsed person’s
shoulders.
■ Turn on the AED.
■ Follow the verbal and visual AED instructions. Make sure that you stick around after the emer-
gency responders arrive so that any institutional re- ports may be accurately filled out.
Note. AEDs are not meant to be used on patients less than 55 pounds or who are under the age of eight.
Types of Defibrillators
The different kinds of defibrillators in use today in- clude the manual external defibrillator, manual in- ternal defibrillator, AED, implantable cardioverter- defibrillator (ICD), and wearable cardiac defibrillator.
■ Manual external defibrillator: These defibrilla- tors require more experience and training to effectively handle them. Hence, they are only common in hos- pitals and a few ambulances where capable hands are present. In conjunction with an ECG, the trained pro- vider determines the cardiac rhythm and then manu- ally determines the voltage and timing of the shock— through external paddles—to the patient’s chest.
■ Manual internal defibrillator: The manual in- ternal defibrillators use internal paddles to send the electric shock directly to the heart. They are used on open chests, so they are only common in the operat- ing room. It was invented after 1959.
■ AED: These defibrillators use computer tech- nology, making it easy to analyze the heart’s rhythm and effectively determine whether the rhythm is shockable. They can be found in medical facilities, of- fices, airports, hotels, stadiums, and schools.
■ Implantable cardioverter-defibrillator: Another name for this is automatic internal cardiac defibrillator (AICD). They constantly monitor the patient’s heart, similar to a pacemaker, and can detect ventricular fi- brillation, ventricular tachycardia, supraventricular tachycardia, and atrial fibrillation. When an abnormal rhythm is detected, the device automatically determines the voltage of the shock to restore cardiac function.
■ Wearable cardiac defibrillator: Further re- search was done on the AICD to bring forth the wearable cardiac defibrillator, which is a portable external defibrillator generally indicated for patients who are not in an immediate need for an AICD. This device is capable of monitoring the patient 24 hours a day. It is only functional when it is worn and sends
36 Occupational Health & Safety | FEBRUARY 2018
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