2-Person AED

Some of this will be a review of what you learned in the cardiac arrest section – using an AED on an adult patient.

>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.

Warning: When using an AED, there are a couple of important things to keep in mind as it relates to your surroundings.

• Are there combustible gases or liquids at the scene?
• Are there any liquids that could connect the victim with yourself, the responder, or someone else, that could result in electrocution?

These are two important considerations before using an AED, but there are a few other things to note when defibrillating an adult patient.

• If the victim is female and wearing an underwire bra, it shouldn't present any complications. However, if the bra is a concern, you can adjust the straps or cut it away and remove it. Just make sure the AED pads are on bare skin.
• Necklaces should be moved to the side
• Any patches – nicotine, analgesic, nitro gel, etc. – should be removed if they are in the way of the pads
• Piercings shouldn't cause any problems
• It's OK if the victim or the victim's clothing is wet, as long as the chest area is dry and you or the victim aren't submerged in water or connected by it
• There are no special considerations for pregnant women

How to Provide Care

As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy (or bag valve mask when there are two responders) and begin calling out to the victim to assess whether or not he or she is responsive.

Are you OK? Can you hear me?

If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps.

• Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc.
• Continue to assess the victim's pulse and breathing. 
• Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse.
• Check for breathing while you are checking for a pulse. The patient may be breathing fast or slow, deep or shallow breathing, etc. Remember, gasping is not normal breathing and may be a sign the victim does not have a pulse.
• If you've determined at this point that the victim is unresponsive, is not breathing normally, and has no pulse, start CPR with compressions and have the second responder immediately set up and use the AED.

Two-Person AED Technique for Adults

Responder one:

• Locate proper hand placement and begin chest compressions – between the breasts and on the lower half of the sternum.
• Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper bodyweight to supply the force for the chest compressions, and count as you perform them.
• Conduct compressions that go 2-2.4 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
• Perform 30 chest compressions.

Responder two:(while responder one performs compressions)

• Turn on the AED.
• Remove the patient's clothing to reveal a bare chest and dry the chest off if it's wet.
• Attach the AED pads to the patient's chest. The pads should have a diagram on placement if you need a reminder. The first pad goes on the top right side of the chest. The second pad goes on the bottom left side mid axillary, under the left breast. Make sure they adhere well.

• Plug the cable into the AED and be sure no one is touching the patient, including yourself and your partner. The AED should now be analyzing the rhythm of the patient's heart.
• If the AED finds a shockable rhythm, it will charge and tell everyone to clear from touching the victim.
• If the scene is clear and no one is touching the patient, push the flashing shock button.

Responder two:

• Immediately take over compressions from responder one. Ensure proper body mechanics and perform 30 chest compressions.
• It's appropriate to perform CPR over the pads, when needed. It is best practice to not remove the AED pads once they are applied.

Responder two:

• Grab the bag valve rescue mask and seal it over the victim's face and nose. Lift the patient's mandible up into the mask – using the CE form to seal the mask – and incorporate the proper head-tilt, chin lift as you do.
• Slowly, over 1 second, compress the bag valve mask about half the volume, or just until you see the chest rise. Wait for the chest to fall, about 2 seconds, before administering the second breath.

• After about five cycles of CPR, the AED will analyze the patient again. If the AED advises you to perform another shock, make sure no one is touching the patient and press the shock button
• Go right into CPR. (This is the switch point.) strong>Responder two goes from AED and valve mask duties to compressions, while responder one takes over bag valve mask duties and control of the AED.

Continue this cycle of CPR, re-analyzation, switching positions, charging, shocking, and back into CPR until help arrives, the patient is responsive and breathing normally, or the next level of care takes over.

A Word About AED Maintenance

For AEDs to function properly, they must be maintained like any other medical device. However, the maintenance they require is minimal.

Though AEDs have various self-testing features, it's important that healthcare professionals become familiar with any visual or audible prompts the AED may use to warn of a low battery or malfunction. If the machine detects a malfunction that cannot be easily resolved by addressing the manual, you should contact the manufacturer. It may need to be returned for service.

While AEDs require minimal maintenance, it's still important to remember the following:

• Follow the manufacturer's recommendations for periodic equipment checks
• Make sure that the batteries are not expired or low energy. Most AEDs have windows that you can easily see the status of the battery. (It may be a good idea to order a new battery months before it expires or is showing that it is low energy.) 
• Make sure the AED includes the correct defibrillation pads and that they remain sealed. Opened AED pad packaging can cause the pads to dry out and become ineffective when needed
• Periodically check expiration dates on the defibrillation pads and batteries, and replace as necessary
• After using your AED, make sure that all the accessories are back in the case and that the machine is in proper working order for its next use
• If at any time the AED fails to work properly, discontinue its use and contact the manufacturer immediately