Page 245 - 2023 SMOG Digital

CARDIAC DEFIBRILLATION

CLINICAL INDICATIONS:
• Patient who is in pulseless cardiac arrest with either ventricular fibrillation or ventricular tachycardia seen on
monitor.
CONTRAINDICATIONS:
• None
PROCEDURE:
• Ensure patient attached to monitor/defibrillator. If paddles used, ensure that they are several centimeters
away from monitor leads to prevent arcing. Use pediatric paddles as indicated – if unavailable and pads used,
should place in anterior/posterior position for pediatric patients.
• Set energy level to appropriate level. Start 200J adult (biphasic) or 360J adult (monophasic), or 2J/kg
pediatric.
• Press “charge” button 30 seconds prior to end of compressions. This maneuver minimizes time between
compressions and defibrillation. Compressions should continue until end of cycle.
• Ensure all personnel clear of patient and pilots aware of cardioversion.
• Press and hold “shock” button until energy delivered.
• If rhythm converts–treat as per post resuscitation protocol.
• Following shock delivery, immediately begin/return to CPR for 2 minutes before checking for pulse.
• If pediatric patient fails to convert–repeat steps 2-7 above using escalating energy levels.
• Document procedure, results, and vital signs on run sheet following mission.

AUTOMATED EXTERNAL DEFIBRILLATOR (AED):
• Turn on power to machine and follow prompts to attach pads to patient and machine.
• Ensure no one touching/moving patient and press the “Analyze” or equivalent button. (If not present, the
machine will automatically check the rhythm at dedicated time intervals. A vocal warning will tell you when
this is occurring).
• If shock advised, press button to deliver shock and return to CPR for 2 minutes.
• After analysis, if subsequent shocks advised, repeat steps 2-3 up to 3 shocks, until further care arrives, or
until no further shock advised. If no shock advised at any time, CHECK PULSE. Continue CPR if no
pulse. If pulse present, place patient in recovery position and transport.

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