The most effective treatment for sudden cardiac arrest is rapid defibrillation. During the primary survey determine unresponsiveness, lack of breathing and pulselessness. Call for help and activate the EMS system. Begin CPR. Now let's throw this life-saving piece of machinery into the mix.

Your initial steps will be the same. No changes will occur until you determine the patient has no pulse. At this point, you will turn to the AED, rather than chest compressions. The AED should be placed close to the patients head. Turn the AED on and follow the voice prompts. You will be directed to "apply pads to patient's bare chest." k To do this, simply peel the pads off one at a time and place them on the patient's chest as illustrated. The correct areas of pad placement are one on the "upper right portion of the chest ,near the collarbone and the ,other on the lower left side of the ribcage.

The defibrillator will then advise you to "clear" the patient. Visually and verbally ensure no one is touching or moving your patient by sweeping your hand above the patient and stating, "Stay clear of the patient!" the pads allow the machine to monitor and read the patient's he rhythm. Follow he AED voice prompts as it makes a "shock" or "no shock" decision. Remember, if "no shock" prompt is given, the machine will advise you to asses the patient's airway, breathing and circulation and, if needed, begin CPR.

If, when you check the ABC's, the patient has a pulse but is not breathing adequately perform rescue breathing. If there is no pulse , perform CPR. Should a pulse and breathing return, continue to monitor the patient and provide a hand - off report to EMS when they arrive. If an AED is not immediately available, perform CPR until one becomes available.

Automatic external defibrillators have a monitoring device located inside the machine which will record the events of its use. This device is approximately the size of a credit card and can be used with a computer to download the information. It is essential you leave the pads attached to the patient and plugged into the machine until EMS arrives. The AED will continue monitoring the patient and will frequently prompt you to "clear" the patient for evaluation. By following machine prompts and performing CPR when needed, you will greatly increase your patient's chance of a full recovery.

Some cardiac patients have conduction problems with their heart and need artificial pacemakers implanted. These are normally located in the upper left chest area, just below the collarbone. These devices either pace the heart all the time or "on demand" when the heart rate drops below a certain level. Due to their placement, a pacemaker is usually not a problem with an AED since pad placement does not interfere with pacemaker occasion. The only consideration is the battery pack that powers the pacemaker. This may be implanted in the left lower abdominal wall. If this is the case, a scar should be visible well as the outline of the battery pack. Make certain the left defibrillator pad is at least 3-4 inches away from the battery pack

Unless born with some sort of cardiac, children rarely suffer sudden cardiac arrest. When a child arrests, airway obstruction, drowning or trauma are usually the primary causes. The general rules for AED use in children is they must be at least 8 years of age and must weigh more than 55 pounds. Several AED manufacturers have developed pediatric pads. These pads are designed to reduce the amount of electricity delivered to the child's heart.

One common method of medication delivery is to provide a patient with a transdermal patch. A variety of medication patches delivering nicotine, hormone replacement, birth control or nitroglycerin are available today. If you encounter a patient in cardiac arrest with a medication patch on their chest, it may present a safety hazard during defibrillation. Remove the patch with a gloved hand and wipe the area clean. Apply the AED pads and proceed as you normally would.

In recent years, AED's have been popping up in all sorts of public places. Shopping malls, airports, golf courses, casinos and sports venues have been leading the way. Commercial airlines have joined in as well. Many airlines are now equipped with AED's for your safety. Chicago's O'Hare airport installed AED's in their terminals and have already experienced several `saves'. Las Vegas, with their high-rise casinos, have also jumped on the AED band wagon and have reported many saves in just the first few years of use.

The time has come to familiarize yourself and your family with defibrillators and their use. It won't be long until the sudden cardiac arrest patient who survives, will leave the hospital with prescriptions for blood thinners, blood pressure medication and an AED. The price on the machines is dropping rapidly and becoming affordable for the lay public. AED's may very soon be available for purchase in drugstores. Our hope is that someday soon, AED's will be as common as fire extinguishers. During your next visit to a populated public facility, look around for your nearest AED.

Although there are a number of brands of defibrillators, they are all very similar. AED's are extremely reliable and require very little maintenance. However, as with all mechanical equipment, routine maintenance or repair may be necessary. Depending on which AED you use, it is important to adhere to manufacturer's recommendations to help assure that the AED will be operable when needed.

In most states, a person or entity who owns a defibrillator must ensure it is maintained and tested according to the manufacturer's operation guidelines. In addition, medical direction must be gained from a licensed physician in order to use a defibrillator. The person or entity that acquires a defibrillator must notify their local EMS agency about its existence and location. If the defibrillator is used, EMS must be contacted immediately to assure continuity of patient care.

Recent legislation created guidelines to place AED's in all federal buildings to combat SCA. With more than one million employees working in federal buildings in this country, this is a significant step in saving lives. It has also included AED usage under the Good Samaritan law. The same conditions apply; don't take payment for helping, act within your scope of training and act within the accepted standards for use of a defibrillator. This new legislation is making defibrillators more widely available and more easily used.

These treatment intervention guidelines are based upon on the Guidelines for Cardiopulmonary Resuscitation (CPR) Emergency Cardiac Care, JAMA 2001 and the National Guidelines for First Aid in the Occupational Setting (NGFATOS) AED enrichment module. The actual use of an AED should allow local protocols and/or standing orders in conjunction with the defibrillator manufacturer's recommendations for operation and maintenance.

The following steps illustrate the treatment priorities and methods for delivering a shock using an AED. If you have an AED available at your work or home, practice with it every three months and take refresher training at least every 2 years.

1. Establish unresponsiveness - activate EMS by calling 911.

2. Open airway.

3. Assess breathing - provide rescue breaths, if needed.

4. Check pulse and signs of circulation - if no pulse, perform CPR until an AED is available. When AED becomes available...

5. Turn AED on and follow voice prompts.

6. Bare the patient's chest, attach defib/monitoring pads.

7. When AED analyzes patient, discontinue CPR and don't touch the patient. Verbally and visually clear the patient.

8. Deliver shock if indicated by the AED, continue to follow prompts.

I can't get the pads to stick to my patient's wet 8. hairy chest.

Although very sticky, the AED defibrillation/monitoring pads may not stick well to very hairy or wet skin. It is common for an SCA patient to be sweaty. Using a dry cloth, wipe the patient's chest and reapply the pads. If your patient is excessively hairy, it may be necessary to quickly shave the areas with a disposable razor, then reapply the pads.

I've already delivered one shock and now the machine is advising a second shock. Is this OK?

Actually, yes. It is very common for the AED to deliver multiple shocks in an attempt to convert the heart to a perfusing rhythm. This is where your trust of the machine comes into play. Continue following the voice prompts and do what the machine tells you to do. It has the knowledge to do what is best for your patient.

Would I really get shocked if 1 touch the patient during defibrillation?

Oh yeah! Depending on the area of the patient's body you are touching, you may get a serious jolt. Although it probably won't kill you, you would be unlikely to do it again. It is very important that no one is touching the patient during analyzing or shocking. It is suggested you verbally ("Everyone clear the patient, stay away from the patient") and visually (sweep your hand over the top of the patient and look to ensure everyone is away) clear the patient each time you analyze or deliver a shock. Concerned family members will be your greatest challenge, but ensure them the best treatment they can give is concern from a few steps away.

After delivering 3 shocks, the machine stated "no shock indicated." I continued CPR for a few minutes, then the AED told me to clear the patient for analyzing. What did 1 do wrong?

Absolutely nothing. In fact, you did everything right. The AED continues to monitor the patient's heart rhythm. Perhaps, during your effective CPR, the AED picked up something in the patient's rhythm that could be shockable. You have been instructed to leave the AED attached to the patient and on for this very reason. It will continue to monitor the happenings inside the heart and hopefully be able to convert your patient.

• The AED should only be applied to an unresponsive patient with no pulse.
   
• The AED is normally designed to work between 32-122 degrees Fahrenheit. While it may work outside that range, there is no guarantee.
   
• Temperature is a factor with AED's. Pads are affected by excess heat. By comparison, battery performance is affected by extreme cold.
   
• Always make certain to verbally and visually "clear" the patient prior to analyzing or shocking.

Stroke

Discussed in detail in a following section, stroke is the third leading cause of death in the United States. Severe stroke may lead to cardiac arrest.

Hypothermia

The protocol for resuscitation of the hypothermic patient is similar to that of a normal cardiac event. Treatment centers on gently rewarming the patient, calling for help, monitoring ABC's, defibrillation 8. CPR as needed.

Traumatic Arrest

Cardiac arrest secondary to trauma can be a grave situation. Because the underlying cause may be difficult to correct, your priorities do not differ from cardiac arrest of other causes. Defibrillation can be safely used on a trauma patient, but the efficacy may be diminished.

Pregnancy

The use of CPR on expectant mothers is unique because of the difference in cardiac and respiratory function. During pregnancy, cardiac output can increase up to 50%. Heart rate and oxygen consumption also increase. These changes cause the pregnant woman to be more susceptible to and less tolerant of cardiac changes. Additionally, when fiat on her back, the uterus can compress the major blood vessels of the lower body, resulting in decreased cardiac output. To overcome this, place a pillow under the patient's right hip to help facilitate blood return to the heart.

Asphyxiation

Asphyxiation or suffocation occurs most commonly when a gas other than oxygen is inhaled. This may occur during chemical spills, gas leaks or fires. In the home, carbon "monoxide is a common cause. Whatever the cause, the result is insufficient oxygen reaching the brain. This results in unresponsiveness and can lead to cardiac arrest. After ensuring your own personal safety, you should perform the ABC's and normal CPR techniques as needed. AED's can be used as well.