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In this lesson, we'll cover one-rescuer adult AED usage for the healthcare professional, including baseline environmental checks, clearing physical obstructions on the patient, and managing the workflow between the AED and CPR cycles.
An AED (Automated External Defibrillator) is a portable electronic device that analyzes the rhythm of the heart and delivers an electrical shock, known as defibrillation, which helps the heart re-establish an effective rhythm.
AED Environmental Safety Checklist
Before powering on or delivering a shock with an automated external defibrillator, it is vitally important that you pause to evaluate your immediate surroundings for specific safety hazards:
- Combustible Gases: Ensure there are no explosives or volatile gases present in the area.
- Liquids & Standing Water: Look for any liquids that could connect the victim with yourself or other responders. Being submerged or lying in a pool of water poses a direct threat of electrocution during defibrillation.
Pro Tip #1: If the environment is unsafe due to standing water or dangerous materials, drag or move the patient to a dry, clear area before attempting to analyze their cardiac rhythm or deliver a shock.
Managing Patient Barriers and Obstructions
Healthcare professionals often ask about physical items on a patient's body when preparing to defibrillate an adult patient. Use these rules to handle potential complications seamlessly:
- Underwire Bras: Modern AED technology handles these well without significant complications. However, if you believe the metal wiring rests directly in the electrical pathway, disconnect or remove it so the pathway remains clear between the two electrodes.
- Jewelry & Necklaces: If a necklace rests where an electrode needs to go, simply move it to the side.
- Medication Patches: If a nicotine, analgesic, or nitro gel patch is in the direct path of an electrode, pull it off completely and wipe the skin clean before adhering the pad.
- Piercings: Body piercings typically do not present an issue; place your pads over the chest normally.
- Wet Clothing vs Drowning: A drowning victim can remain in wet clothes as long as they are pulled out of the standing body of water and their immediate chest area is wiped completely dry.
Pro Tip #2: When treating a pregnant patient in cardiac arrest, you must be just as aggressive as you would with any other adult patient. Your primary target is saving the mother; prioritizing her care is the absolute best way to ensure the safety and survival of the baby.
Proper Steps for Treating a Patient with an AED
1. Verify Responsiveness: Shout to assess the victim's status (*"Are you alright? Can you hear me?"*). If they do not respond to your voice, place a hand on their forehead and firmly tap their collarbone.
2. Activate the Code: If the patient remains completely unresponsive to taps and shouts, immediately activate emergency services (call 911 or call for your facility's code team).
3. Check Pulse and Breathing: Simultaneously check for normal breathing and feel for a carotid pulse for no more than 10 seconds. If they are unresponsive, have no pulse, and are not breathing normally, proceed directly to your AED.
4. Apply the Device: Turn the AED on immediately. Expose the patient's chest and apply the pads firmly according to the illustrated diagrams. The first pad goes on the upper right side of the chest; the second goes on the bottom left side (mid-axillary, just below the left breast).
5. Analyze Rhythm: Plug the pad cable into the device and shout for everyone to stand clear. Ensure no one touches the patient while the AED analyzes the underlying rhythm.
Delivering Shocks and Clearing the Patient
When the AED finishes charging and prompts you to clear the area, visually confirm that no one is touching the patient's body or bedding before depressing the flashing shock button. Failing to clear the scene can result in severe accidental shock to a team member.
6. Resume CPR Cycles: The moment the shock is delivered, transition directly into chest compressions. Compress the chest at a depth of 2 to 2.4 inches and at a rapid rate of 100 to 120 compressions per minute. Maintain a strict cycle of 30 compressions followed by 2 rescue breaths over the next two minutes until the AED instructs you to clear and re-analyze.
