The Defibrillation Process - Life Saving Victoria

DEFIBRILLATION 

PUAOPE010A Operate a semi automatic defibrillator in an emergency 

Chapter 24 – Defibrillation 

© Surf Life Saving Australia – Version 2 

SLSA Defibrillator Course / PUAOPE010A Operate a semi automatic defibrillator in an emergency 24.1

UNIT 24 – 

DEFIBRILLATION 



Defibrillation 

What is Defibrillation? (pg 173) 

What is an SAED? (pg 173) 

Chain of Survival (pg 173) 

The Electro-cardiogram (pg 174) 

Cardio Rhythm and Arrhythmias (pg 174) 

Types of SAED (pg 175) 

The Defibrillation Process (pg 175) 

Defibrillation Safety (pg 177) 

(Page numbers relate to the Surf Life Saving 

First Aid and Emergency Care Manual) 




Chance of Survival 

% 

100 

90 

80 

70 

60 

50 

40 

30 

20 

10 

0 

Sudden cardiac arrest is one of the leading 

causes of death in Australia 

Survival rates decline dramatically with each 

minute that passes without defibrillation 

1 2 3 4 5 6 7 8 9 10 

Time Elapsed in Minutes 



What is Defibrillation? 

Ventricular fibrillation (VF) is the rapid, irregular 

and uncoordinated contraction of the heart 

Defibrillation involves delivering an electric shock 

to revert the heart to its normal rhythm 

Heart attack is a common cause of VF 

• Heart ceases to function effectively 

• Can cause permanent damage or death 

• Defibrillation is most effective method to reverse VF 



What is an SAED? 

An Semi-automatic external defibrillator (SAED) is: 

• A portable device 

• Able to recognise shockable rhythms in a patient in 

cardiac arrest 

• Able to deliver an electrical shock to revert the heart back 

to its normal rhythm 



Chain of Survival 

Early 

Access 

Early 

CPR 

Early 


Early 

Advanced 

Care 

To get 

Help 

To buy 

time 

To restart 

Heart 

To 

stabilise 




Early Access 

‘Avoids delay in obtaining assistance’ 

• Cause/recognition of Cardiac Arrest 

• Scene Survey 

• Primary Survey 

• Calling for Help 

• Secondary Survey 

Early Access ... 

‘000’ 

… to get help 




Early CPR 

‘Buys time’ 

• Extends duration of ventricular defibrillation 

• Keeps vital organs 

oxygenated 

• Delays irreversible 

brain damage 

Early CPR ... 

… to buy time 




Early Defibrillation 

‘Increases sudden Cardiac Arrest victim 

survival chances’ 

• Re-establishes normal 

rhythm in the heart 

• Combined with Early 

CPR allows victim best 

survival chance 

Early Defibrillation ... 

… to restart heart 




Early Advanced Care (Life Support) 

‘Treatment by Medical Personnel/Paramedics’ 

• Beyond scope of 

First Responders 

• More effective if 

previous three links 

are completed 

early/effectively 

Early Advanced Care ... 

… to stablize 



The Electrocardiogram 

Actions of the heart 

1) Mechanical action: 

the pumping of the heart 

2) Electrical action: 

controls the rhythmic beat of the heart 

The electrical impulse passing through the 

heart muscle can be mapped on a graph 

called an electrocardiogram (ECG) 




Revision: Heart Mechanical Action 

Right Atrium - Receives Blood from Body 

pumped into: - 

Right Ventricle - Pumps Blood to the Lungs 

Left Atrium - Receives Blood from Lungs 

pumped into: - 

Left Ventricle - Pumps Blood to the Body 




The Electrical Action of the Heart 

The normal pathway of electrical impulse 

through the heart is: 

• SA (Sinoatrial) Node – pacemaker 

• AV (Atrioventricular) Node 

– Electrical gateway between atria and ventricles 

• Right and Left Bundles/Purkinjie fibres 

– Distribution network of electrical impulse 

to both ventricles 

Normal Heart Rates: 

Infants/newborn 100-160 beats/min 

Children 70-120 beats/min 

Adults 60-100 beats/min 



Cardiac Rhythm & Arrhythmias 

SAEDs designed to 

detect life 

threatening 

arrhythmias: 

• VF - recommend 

defibrillation 

No need to identify 

differing rhythms 

Following slides for 

information only 




Sinus Rhythm: 

• Sinus rhythm is the normal rhythm of a healthy heart 

• SAED will not recommend, nor allow, a shock if normal 

sinus rhythm is detected 




Ventricular tachycardia (VT): 

• Ventricular tachycardia (VT) occurs when the 

ventricles beat faster than the rhythm generated 

by the sinoatrial node 

• May be life threatening as it may inhibit effective 

distribution of oxygenated blood 




Ventricular tachycardia (VT): 

Symptoms 

• Very rapid pulse, or no pulse 

• Palpitations – heart racing 

• Light-headedness or dizziness 

• Angina or chest pain 

Signs 

• Fainting 

• Difficulty breathing 

Treatment 

• If VT progresses to a pulseless VT, 

>180 beats/min, SAED will recommend a shock 




Ventricular fibrillation (VF): 

• Ventricular fibrillation (VF) is characterised by disordered 

electrical activity and unsynchronised, very rapid 

ventricular fluttering 

• Ventricles cannot pump blood throughout body resulting 

in no cardiac output and no pulse 

• This is life-threatening and results in collapse with 

cardiac arrest 




Ventricular fibrillation (VF): 

Signs 

• Loss of consciousness 

• No breathing, no “signs of life” 

Treatment 

• DRABC 

• Defibrillation 




Asystole: 

• There is very minimal electrical 

activity during ventricular asystole, 

but no contraction of the heart 

muscle and, consequently, no pulse 

• CPR is the only treatment 

• SAED will not recommend a shock 

if this rhythm is detected 



Types of SAED 

Monophasic: 

• The electric current is 

triggered and passes 

only from one pad to 

the other 

• They deliver a preset 

charge of 200kJ on the 

first and second shocks, 

and then a 360 kJ for 

the third and subsequent 

shocks 



Types of SAED 

Biphasic: 

• The charge goes from one pad to the other and then returns 

• It is possible to run them at a lower voltage. 

• The usual charge can be less than the monophasic models, 

but just as effective (Laerdal FR2 – 150 kJ) 



The Defibrillation Process 

The SAED: 

• Delivers an electric 

shock through 

electrodes 

• This STOPS the 

heart’s abnormal 

activity 

• Restoring normal 

sinus rhythm 




Indications for use of SAED: 

• The patient is unresponsive 

• The patient is not breathing 

• The patient has no “signs of life” 

• The first aider has access to the SAED 

• The first aider is trained/certified in the use of SAED 

• SLSA Policy : 

Only to be used on patients 

over 8 years or 40kg 




When connected the SAED will: 

• Prompt specific actions 

• Analyse patient’s ECG 

• Advise: 

– Shock (if appropriate rhythm) 

– Or recommence CPR 

• Deliver shock when activated by operator 




Operation of the SAED 

Confirm patient in need: 

• Unresponsive, No breathing, No “signs of life” 

Safe Conditions: 

• No Water, No Metal 

• No pacemaker/patches 

• Oxygen approx. 1m from patient 

• No one touching patient 

• Turn on defibrillator 

• Respond to prompts 

• Deliver shock 

• Maintain Basic Life Support protocols 




Effective adherence of electrode pads 

• Only place electrode pads on clean, dry skin 

• Do not use alcohol wipes 

• If chest is hairy, remove hair with razor or shears 

• Apply electrode pads with a 

smooth rolling action to 

prevent air bubbles 

• Once applied, electrode 

pads should not be 

repositioned or removed 

• Do not use electrodes after 

their expiry date 




Positioning of electrode pads 

• Place sternum electrode pad to the 

right of the sternum (breastbone) 

below the collarbone and above 

the right nipple 

• Place the apex electrode pad to the left 

of the sternum, with upper edge of pad 

below and to the left of the nipple 

Do not remove electrodes after 

pulse return 

Do not place over patches 

At least 10cm from pacemaker 




Accessories: 

• Resuscitation masks 

• Gloves 

• Razors 

• Shears 

• Gauze wipes (or similar) 

• Spare battery (if applicable) 

• Space blanket 

• Pen and paper 

• Chamois or towel 




Shock Delivery Protocols 

Depending on age and type of SAED, there may 

be various Protocols: 

• One shock, or 

• Three shock clusters 

Varying shock output: 

• Biphasic or Monophasic 

• 150kJ, 200kJ or 360kJ 

Follow the prompts of 

the SAED you have 





One Shock Delivery 

As soon as machine is available: 

• Cease CPR 

• Deliver one shock 

• Check for signs of life 

Follow prompts: 

• 2 minutes CPR or Lateral position 





Three Shock Delivery: 

As soon as machine is available: 

Follow prompts: 

• Usually three shocks in a “cluster” 

• followed by a minute of CPR 

• followed by three more shocks, etc 



Defibrillation Safety 

Safety Considerations: 

• Operator must be trained/certified in the use of the 

defibrillator 

• Patient must be unresponsive - not breathing, 

no “signs of life” 

• Remove any metallic jewellery near the electrode sites 

• Do not place electrodes over medication patches 

• Avoid contact between electrodes and metal surfaces 

• No contact with patient during shock delivery 

– “I’m clear, you’re clear, everybody’s clear” 

• Do not operate SAED in an explosive environment 



Defibrillation Safety 

Safety Considerations continued… 

• In wet conditions wipe chest dry before positioning 

electrodes 

• Make sure pads are at least 10cm away from an 

implanted pacemaker 

• Use only equipment that is compatible with the unit 

• Do not operate the unit in close proximity to mobile 

phones, radios etc 

• Do not operate the unit in an unstable environment 

which may prevent valid assessment of ECG signal 

• Be aware of an incoming tide (if applicable) 



Equipment Maintenance 

SLSA Defibrillation Policy and Procedure 

• Refer to SLSA Policy 

• Storage and pre-patrol and post checks 

Minor Faults and Repair 

• Charge – battery replacement 

• Electrode pads – date and still sealed 

• Other minor faults as per manufacturer guidelines 

Major fault reporting 

• Patrol Captain notified 

• Recorded in patrol log 

• Club official notified for immediate repair 



Thank You

The Defibrillation Process - Life Saving Victoria

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