# Automated External Defibrillation (AED)

## Overview

This module describes how to use an automated external defibrillator (AED) as part of cardiopulmonary resuscitation (CPR). AEDs provide audio prompts and are suitable for lay person use.

## Indications

1. Cardiac arrest

## Contraindications

1. Patients with palpable pulse

## Patient information & consent

This procedure is done for cardiac arrest, so consent is generally implied. Patients with “Do Not Resuscitate” (DNR) orders, “Not For Max” orders, or living wills that specify that no resuscitation may be performed, should not be resuscitated.

## Preparation

Using an AED is an emergency procedure. Always:

1. Carry gloves and a CPR protective device for emergencies outside the hospital environment.
2. In public places such as airports and malls, look out for AEDs and first aid stations attached to walls.
3. Memorise emergency phone numbers, or keep them on your cell phone, to call for help.

## Site & Positioning

The patient should be lying flat on their back on a firm surface with their chest exposed. All clothes, including undergarments, should be removed from the chest.

## Procedure

Follow medical asepsis with non-sterile gloves. The AED should be used as soon as it arrives. If a second rescuer is busy performing chest compressions, do not interrupt chest compressions until ready to shock (step 5 below).

1. Switch On the AED.
2. Follow the audio prompts:
3. Attach the two pads to the patient’s bare chest according to the diagram.
   1. Choose the correct pads (Adult vs Child)
   2. Peel the backing away from the AED pads
   3. Attach the adhesive AED pads to the victim’s bare chest. Follow the placement diagrams on the pad.
4. Plug in the leads from the pads if necessary.
5. Tell everyone to stand clear, then press the Analyse button. Don’t touch the patient while analysing.
6. If the AED recommends a shock tell everyone again to stand clear, (“Everyone clear!”) and make sure nobody is touching the patient.
7. Press the Shock button.
8. If a shock is delivered or the AED prompts “no shock advised” immediately resume high quality CPR, starting with chest compressions.
9. After every 2 minutes (or 5 cycles) of CPR, the AED will automatically prompt you to stop CPR and will analyse the rhythm and advise if a shock is required.
10. Stop if any signs of life are present, or if a senior clinician declares the patient dead.

## Troubleshooting

The patient has a lot of breast tissue.

Always try to place pads under or lateral to breasts. Large breasts can compromise the effectiveness of the shock delivered.

My patient is soaking wet.

Wipe the patient down quickly before applying pads. If the patient is in water pull them out.

My patient is so hairy I can’t get contact with the skin.

Use a razor if available to shave the contact areas, or use any kind of adhesive dressing or extra pads to “wax” off the worst of the body hair.

My patient is wearing an underwire bra.

Cut it off. The current can run through the underwires, rendering it ineffective, and can cause burns.

My patient has a medication patch on their chest.

Remove it and wipe the area quickly.

My patient has an implanted pacemaker or defibrillator.

Don’t be deterred, but avoid placing your pads directly over the device.

I need to defibrillate an adult but I only have child pads.

It is acceptable to use adult pads on children, but child and infant pads cannot be used on adults.

## Risks

1. Rhythm conversion to an unshockable rhythm
2. Dermal burns to patient
3. Burns & electrical injuries to healthcare providers
4. Explosions and medical fires due to oxygen exposure (rare with pads)

## References

1. American Red Cross. AED steps. Available from: https://www.redcross.org/take-a-class/aed/using-an-aed/aed-steps