Defibrillation Safety Knowledge Table
EOPPE
Environmental Safety Issues
- Do not use around flammable agents, 02 rich atmospheres or anaesthetics
- Do not use the defib on or near water or on metal surfaces
Operator Safety Issues
- Do not defib without first calling ‘Stand Clear’ and checking ‘all clear’
- Just prior to defibrillation, visually check no one else is touching pt or equipment attached to the pt. Maintain visual contact with pt
- When defibrillating, don’t touch pt or equipment attached to the pt other than the monitor
Pt Preparation Issues
- Do not place defib pads over GTN patches, GTN paste, implanted pacemakers or ECG electrodes/ cables
- Avoid skin pigmentations and nipples to prevent burns
- Avoid skin folds to prevent electrical arching
- Do not allow contact between pads and or ECG electrodes or cables
Pad Adhesion Issues
- Do not defib if the pads are not properly adhering to the pt
- Do not perform chest compressions over the defib pads
Equipment Issues
- Damaged therapy cables must be replaced
- Faulty defib pads must be replaced
- If the monitor displays the stop symbol in the RFu indicator window, it indicates monitor failure and should be replaced
General Defib Contraindications
- Any pt movement (except synchronised cardioversion)
- Any pt with a pulse (Except for synchronised cardioversion)
- Any stretcher movement
- Any person touching the pt. There must be no pt contact when the monitor is analysing, charging or delivering a shock
AED Contraindications
- Pts who are 11 years of age or less
- An ambulance that is not stationary. must be bought to a halt
- All general defib contraindications
Defib Pad Placement
- Apex Pad: placed horizontally on the pts left side, on the mid axillary line at the level of the cardiac apex
- Sternal Pad: placed horizontally on the pts right chest under the right clavicle, above the right nipple
Defib Pad application technique
- Apply the pad in a rolling motion to avoid air pockets
- Smooth the pad into the intercostal spaces of thinly built people
- Apply gentle pressure over the entire surface of the gel and adhesive ring to ensure adhesion
- Roll sternal pad from the right sternal margin, with the cable end of the pad pointing away from the pt
- Roll apex pad from the anterior aspect of the cardiac apex, with the cable end of the pad pointing away from the pt
Defib Pad pre- application check
- Check expiration date of the pads
- Check for dried out or damaged pads
Chest Preparation measures
- Wipe moist or sweaty skin with a dry towel only. Do not use betadine or alcohol wipes as they can cause burns and interfere with pad adhesion
- Clip chest hair only when coarse, dense and wiry. Refrain from shaving as this can cause electrical arching.
Weight/ Age limit of defib pads
As per manufacturers instructions
Paediatric Defib pad application
- As close as possible to adult placement i.e. Anterior/ anterior
- When using Paediatric pads, the anterior pad is placed on the left side, anterior to axillary line with the posterior pad on the right upper chest/ clavicle (same as adult placement’
- Wrapping over the shoulder is permissible to ensure sufficient gap between pads. Avoid the neck
AV Basic ECG Recognition Criteria
- Ventricular Rate
- Ventricular Rhythm
- P waves ?
- PR interval
- QRS interval
Ventricular Fibrillation (VF) criteria
Rate: Non Discernable
Rhythm: Bizarre, chaotic, amplitude >0.1mV
P waves: Nil discernible
QRS: Nil Discernible
Ventricular Tachycardia (VT) criteria
Rate: greater than 100 Rhythm: Regular P waves: not associated or non discernible Pr Interval: non discernible QRS: > 0.12 seconds
Asystole Criteria
rate: non discernible
rhythm: no electrical activity, flat, isoelectric line
p waves: nil discernible
PR interval: nil discernible
QRS: nil discernible
Normal Sinus rhythm criteria
Rate: 60-100 bpm rhythm: Regular P waves: present and associated with each QRS Pr interval: 0.12- 0.2 seconds QRS duration: <0.12 seconds
ECG Paper
1 small square= 0.04
2 small squares= 0.08
large square= 0.2
2 large squares= 0.4
