Performing Emergency Automated External Defibrillation

Goal: The defibrillation is performed correctly without adverse effect to the patient, and the patient regains signs of circulation, with organized electrical rhythm and pulse.

1. Assess responsiveness. If the patient is not responsive, call for help and pull call bell, and call the facility emergency response number. Call for the AED. Put on gloves, if available. Perform cardiopulmonary resuscitation (CPR) until the defibrillator and other emergency equipment arrive.

2. Prepare the AED. Power on the AED. Push the power button. Some devices will turn on automatically when the lid or case is opened.

3. Attach AED connecting cables to the AED (may be preconnected). Attach AED cables to the adhesive electrode pads (may be preconnected).

4. Stop chest compressions. Peel away the covering from the electrode pads to expose the adhesive surface. Attach the electrode pads to the patient’s chest. Place one pad on the upper right sternal border, directly below the clavicle. Place the second pad lateral to the left nipple, with the top margin of the pad a few inches below the axilla.

5. Once the pads are in place and the device is turned on, follow the prompts given by the device. Clear the patient and analyze the rhythm. Ensure no one is touching the patient. Loudly state a “Clear the patient” message. Press ‘Analyze’ button to initiate analysis, if necessary. Some devices automatically begin analysis when the pads are attached. Avoid all movement affecting the patient during analysis.

6. If ventricular tachycardia or ventricular fibrillation is present, the device will announce that a shock is indicated and begin charging. Once the AED is charged, a message will be delivered to shock the patient.

7. Before pressing the ‘Shock’ button, loudly state a “Clear the patient” message. Visually check that no one is in contact with the patient. Press the ‘Shock’ button. If the AED is fully automatic, a shock will be delivered automatically.

8. Immediately resume CPR, beginning with chest compressions. After five cycles (about 2 minutes), allow the AED to analyze the heart rhythm. If a shock is not advised, resume CPR, beginning with chest compressions. Do not recheck to see if there is a pulse. Follow the AED voice prompts. Continue until advanced care providers take over, the patient starts to move, you are too exhausted to continue, or a physician discontinues CPR. Advanced care providers will indicate when a pulse check or other therapies are appropriate (AHA, 2006,).

9. Remove gloves, if used. Perform hand hygiene.