An automated external defibrillator, open and ready for pads to be attached

An Automated External Defibrillator or AED is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient,^[1] and is able to treat them by application of electrical therapy which stops the arrhythmia, allowing the heart to re-establish an effective rhythm. Image File history File links Metadata Size of this preview: 450 × 600 pixelsFull resolution (1728 × 2304 pixel, file size: 783 KB, MIME type: image/jpeg) File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Image File history File links Metadata Size of this preview: 450 × 600 pixelsFull resolution (1728 × 2304 pixel, file size: 783 KB, MIME type: image/jpeg) File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Portable communications devices refer to hand-held or wearable devices. ... Electronics is the study and use of electrical devices that operate by controlling the flow of electrons or other electrically charged particles in devices such as thermionic valves and semiconductors. ... A cardiac arrhythmia, also called cardiac dysrhythmia, is a disturbance in the regular rhythm of the heartbeat. ... Ventricular fibrillation (V-fib or VF) is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. ... Ventricular tachycardia (V-tach or VT) is a fast rhythm that originates in one of the ventricles of the heart. ... A patient having his blood pressure taken by a doctor. ...

AEDs are designed to be simple to use for the layman, and the use of AEDs is taught in many first aid, first responder and basic life support (BLS) level CPR classes.^[2] Look up Layman in Wiktionary, the free dictionary. ... First aid is a series of simple, life-saving medical techniques that a non-doctor or layman can be trained to perform. ... First responder is a term used by national authorities for local law enforcement, local Emergency Medical Technicians (EMTs), local firemen and fire rescue. ... Basic life support (BLS) is a specific level of prehospital medical care provided by trained responders, including emergency medical technicians, in the absence of advanced medical care. ... Wikibooks has more about this subject: First Aid/CPR Cardiopulmonary resuscitation (CPR) is an emergency first aid procedure for a victim of cardiac arrest. ...

Usage

An automated external defibrillator is used in cases of life threatening cardiac arrhythmias, which may lead, or have led to cardiac arrest. The rhythms the device will treat is usually limited to: A cardiac arrhythmia, also called cardiac dysrhythmia, is a disturbance in the regular rhythm of the heartbeat. ...

• Ventricular fibrillation (shortened to VF or V-Fib)
• Pulseless Ventricular tachycardia (shortened to VT or V-Tach)^[1]

AEDs (and all other defibrillators) are not designed to shock asystole or 'flat line' patterns, as this will not have a positive clinical outcome. The asystolic patient only has a chance of survival if, through a combination of CPR and cardiac stimulant drugs, one of the shockable rhythms can be established, which makes it imperative for CPR to be carried out by any lay rescuer prior to the arrival of a defibrillator. Ventricular fibrillation (V-fib or VF) is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. ... Ventricular tachycardia (V-tach or VT) is a fast rhythm that originates in one of the ventricles of the heart. ... In medicine, asystole is a state of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow. ... For other meanings of CPR, see CPR (disambiguation). ...

In each of the two types of shockable cardiac arrhythmia, the heart is in activity (possibly even beating), yet in an unusual pattern, which can be life-threatening if left uncorrected. In ventricular fibrillation, the electrical activity of the heart becomes chaotic, preventing the ventricle from effectively pumping blood. In ventricular tachycardia, the heart beats too fast to effectively pump blood. Frequently, ventricular tachycardia leads to ventricular fibrillation. The fibrillation in the heart decreases over time, and will eventually reach Asystole, with an absence of any rhythm. Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ... In the heart, a ventricle is a heart chamber which collects blood from an atrium (another heart chamber that is smaller than a ventricle) and pumps it out of the heart. ...

Uncorrected, these cardiac conditions rapidly lead to irreversible brain damage and death. After approximately three minutes, irreversible brain/tissue damage occurs. For every minute that a person in cardiac arrest goes without being successfully treated (by defibrillation), the chance of survival decreases by 10 percent. Brain damage or brain injury is the destruction or degeneration of brain cells. ... This article or section does not adequately cite its references or sources. ...

AED's are designed to be used by laypersons, who ideally should have received specialist training. They are usually limited in their interventions to delivering high joule shocks for VF and VT. This is in contrast to more sophisticated manual and semi-automatic defibrillators used by health professionals, which can act as a pacemaker if the heart rate is too slow (bradycardia) and perform other functions which require a skilled operator, able to read electrocardiograms. The delivery of modern health care depends on an expanding group of highly trained professionals coming together as an interdisciplinary team. ... A pacemaker A pacemaker (or artificial pacemaker, so as not to be confused with the hearts natural pacemaker) is a medical device designed to regulate the beating of the heart. ... Bradycardia, as applied to adult medicine, is defined as a resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. ... Lead II An electrocardiogram (ECG or EKG, abbreviated from the German Elektrokardiogramm) is a graphic produced by an electrocardiograph, which records the electrical voltage in the heart in the form of a continuous strip graph. ...

Placement

An AED at a railway station in Japan. The AED box has information on how to use it in Japanese, English, Chinese and Korean, and station staff are trained to use it.

Automated external defibrillators are generally either held by trained personnel who will attend incidents, or are public access units which can be found in places including corporate and government offices, shopping centers, airports, restaurants, casinos, hotels, sports stadiums, schools and universities, community centers, fitness centers and health clubs. Image File history File links Download high-resolution version (600x800, 81 KB) 駅などに設置されはじめたAED 撮影日：2006年 8月11日 撮影地：東急大井町線大井町駅（東京都品川区大井） 撮影者：cory AED is setting up on some railway station in Japan. ... Image File history File links Download high-resolution version (600x800, 81 KB) 駅などに設置されはじめたAED 撮影日：2006年 8月11日 撮影地：東急大井町線大井町駅（東京都品川区大井） 撮影者：cory AED is setting up on some railway station in Japan. ... This article includes a list of works cited or a list of external links, but its sources remain unclear because it lacks in-text citations. ... For the traditional meaning of the word mall, see mall. ... Toms Restaurant, a restaurant in New York made familiar by Suzanne Vega and the television sitcom Seinfeld A restaurant is an establishment that serves prepared food and beverages to order, to be consumed on the premises. ... This article or section does not adequately cite its references or sources. ... For other uses, see Hotel (disambiguation). ... The Athens Olympic Stadium Typical stadium seating consists of terraces, such as shown here at Sarajevos Stadium Kosevo. ... Students in Rome, Italy. ... The University of Cambridge is an institute of higher learning. ...

The locating of a public access AED should take in to account where large groups of people gather, and the risk category associated with these people, to ascertain whether the risk of a sudden cardiac arrest incident is high. For example, a centre for teenage children is a particularly low risk category (as children very rarely enter heart rhythms such as VF or VT, being generally young and fit, and the most common cause of paediatric cardiac arrest is trauma - where an AED is no use), whereas a large office building with a high ratio of males over 50 is a very high risk environment.

In many areas, emergency services vehicles are likely to carry AEDs, with some Ambulances carrying an AED in addition to a manual unit. In addition, some police or fire service vehicles carry an AED for first responder use. Some areas have dedicated community first responders, who are volunteers tasking with keeping an AED and taking it to any victims in their area. It is also increasingly common to find AEDs on transport such as commercial airlines and cruise ships. First responder is a term used by national authorities for local law enforcement, local Emergency Medical Technicians (EMTs), local firemen and fire rescue. ...

In order to make them highly visible, public access AEDs often are brightly coloured, and are mounted in protective cases near the entrance of a building. When these protective cases are opened, and the defibrillator removed, some will sound a buzzer to alert nearby staff to their removal but do not necessarily summon emergency services. All trained AED operators should also know to phone for an Ambulance when sending for or using an AED, as the patient will be unconscious, which always requires ambulance attendance.

An AED at Chūbu Centrair International Airport in Aichi, Japan.

A trend now being seen is the purchase of AEDs to be kept and used in the home, particularly by those with known existing heart conditions.^[3] The number of devices in the community has grown as prices have fallen to affordable levels (in line with a large television). There has been some concern amongst medical professionals that these home users do not necessarily have appropriate training,^[4] and many advocate the more widespread use of community responders, who can be appropriately trained and managed. Image File history File links AED_at_Centrair. ... Image File history File links AED_at_Centrair. ... ChÅ«bu Centrair International Airport ) (IATA: NGO, ICAO: RJGG) is an airport on an artificial island in Ise Bay, Tokoname City in Aichi Prefecture, south of Nagoya in central Japan. ... Aichi can refer to: Aichi Prefecture Aichi Steel Corporation This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ...

Typically, an AED kit will contain a face shield, for providing a barrier between patient and first aider during rescue breathing; a pair of Nitrile rubber non-allergenic gloves; a pair of Tuff cuts scissors, for cutting through a patient's clothing to expose the chest; a small towel for wiping away any moisture on the chest and a razor for shaving those with very hairy chests. Nitrile rubber is a synthetic rubber co-polymer of acrylonitrile (ACN) and butadiene. ... Trauma shears and foot ruler Trauma shears, often known by the nickname tuff cuts, are scissors used by paramedics and other emergency medical personnel to cut clothes off injured people. ...

Preparation for operation

The use of easily visible status indicator and pad expiry date on one model of AED

Most manufacturers recommend checking the AED before every 'duty' or on a regular basis if a fixed unit. Some units need to be switched on in order to perform its self check. Other models, such as the one pictured, have a self check system built in, with a visible indicator. Image File history File links Metadata Size of this preview: 450 × 600 pixelsFull resolution (1728 × 2304 pixel, file size: 738 KB, MIME type: image/jpeg) File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Image File history File links Metadata Size of this preview: 450 × 600 pixelsFull resolution (1728 × 2304 pixel, file size: 738 KB, MIME type: image/jpeg) File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ...

All manufacturers mark their pads with an expiry date, and it is important to ensure that the pads are in date. This is usually marked on the outside of the pads. Some models are designed to make this date visible through a 'window', although others will require the opening of the case to find the date stamp.

Mechanism of operation

An AED is called external because the operator applies the electrode pads to the bare chest of the victim, as opposed to internal defibrillators, which have electrodes surgically implanted inside the body of a patient. Male Chest The chest is a part of the anatomy of humans and various other animals. ... ICD An implantable cardioverter-defibrillator (ICD), also known as an automated implantable cardioverter-defibrillator (AICD), is a small battery powered electrical impulse generator which is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation. ... An electrode is an electrical conductor used to make contact with a metallic part of a circuit (e. ...

The 'Automatic' part of the title refers to the unit's ability to autonomously analyse the patient's condition, and to assist this, the vast majority of units have spoken prompts, and some may also have visual displays to instruct the user.

Usual placement of pads on chest

When turned on, or opened, the AED will instruct the user to connect the electrodes (pads) to the patient. Once the pads are attached to the patient, everyone should avoid touching the victim so as to avoid false readings by the unit. The pads allow the AED to examine the electrical output from the heart and determines if the patient is in a viable, shockable rhythm (either ventricular fibrillation or ventricular tachycardia). If the device determines that a shock is viable, it will use the battery to charge its internal capacitor in preparation to deliver the shock. This system is not only safer (charging only when required), but also allows for a faster delivery of the electrical current. Image File history File links No higher resolution available. ... Image File history File links No higher resolution available. ...

When charged, the device instructs the user to ensure no one is touching the victim and then to press a button to deliver the shock. Human intervention is usually required to deliver the shock to the patient, to avoid the possibility of accidents. After the shock is delivered, the device will either instruct the user to commence CPR, or will continue to monitor the heart rhythm of the patient to determine if another shock is necessary.

Many AED units have an 'event memory', which store the ECG of the patient along with details of the time the unit was activated and the number and strength of any shocks delivered. Some units also have voice recording facilities, to monitor the actions taken by the personnel, to ascertain if these had any impact on the survival outcome. All this memorised data can be either downloaded to a computer, or printed out, so that the providing organisation, or responsible body (such as a coroner) can see the effectiveness of both CPR and defibrillation on the patients heart.

AEDs available to the public may be semi-automatic or fully automatic. Fully automatic units are likely to have few buttons, often activating as soon as the case is opened, and possibly just one button to shock, or in some cases, this will be performed automatically. The user has no input in to the operation of the unit, apart from attaching the pads, and following the prompts. Health care professionals, and other trained persons, may use a Semi-Automatic defibrillator, which is likely to have an ECG readout display, and the possibility to override the rhythm analysis software. This allows trained personnel to give a higher standard of care, shocking at specific times in the cycle.

The first commercially available AEDS were all of a monophasic type, which gave a high-energy shock, up to 360 to 400 joules depending on the model. This caused increased cardiac injury and in some cases second- and third-degree burns around the shock pad sites. Newer AEDs (manufactured after late 2003) have tended to utilise biphasic algorithms which give two sequential lower-energy shocks of 120 - 200 joules, with each shock moving in an opposite polarity between the pads. This lower-energy waveform has proven more effective in clinical tests, as well as offering a reduced rate of complications and reduced recovery time.

Simplicity of use

Unlike regular defibrillators, an automated external defibrillator requires very little training to use. It automatically diagnoses the heart rhythm and determines if a shock is needed. Automatic models will administer the shock without the user's command. Semi-automatic models will tell the user that a shock is needed, but the user must tell the machine to do so, usually by pressing a button. In most circumstances, the user cannot override a "no shock" advisory by an AED. Some AEDs can even be used on children (those under 55 lbs [25 kg] in weight, or under age 8). If a particular model of AED is approved for pediatric use, all that is required is the use of more appropriate pads. Some organizations, such as the American Heart Association, recommend that if pediatric AED pads are not available, adult pads should be used to determine if the child is in a shockable rhythm. There is insufficient evidence to suggest that a child, in a shockable cardiac arrest, can be "hurt" by an adult defibrillation energy setting. This article or section does not adequately cite its references or sources. ...

All AEDs approved for use in the United States use a electronic voice to prompt users through each step. Because the user of an AED may be deaf or hard of hearing, many AEDs now include a screen to provide visual prompts. Most units today are designed for use by non-medical operators. Their ease of use has given rise to the notion of public access defibrillation (PAD), which experts agree has the potential to be the single greatest advance in the treatment of out-of-hospital cardiac arrest since the invention of CPR ^[5]. The word deaf can have very different meanings depending on the background of the person speaking or the context in which the word is used. ... This article is about hearing impairment in the pathological sense. ... For other meanings of CPR, see CPR (disambiguation). ...

Liability

Most health professionals agree that automated external defibrillators are so easy to use that most, if not all, states in the United States now include the "good faith" use of an AED by any person under the Good Samaritan laws. "Good faith" protection under a Good Samaritan law means that a first aid responder cannot be held civilly liable for the harm or death of a victim by providing improper or inadequate care, given that the harm or death was not intentional (and other certain circumstances). In the United States, Good Samaritan laws^[6] provide protection for the use of AEDs by trained and untrained responders, to a point. Even for trained providers, AEDs provide little liability if used correctly, in fact even the NREMT-B and many state EMT and almost all CPR classes offered incorporate AED education as parts of their program. In addition to the Good Smaritan laws, Ontario in Canada also has the “Chase McEachern Act (Heart Defibrillator Civil Liability), 2007 (Bill 171 – Subsection N)” passed in June, 2007^[7] This legislation now protects individuals from liability for damages that may occur from their use of an AED to save someone’s life at the immediate scene of an emergency, unless damages are caused by gross negligence. A state is a political association with effective dominion over a geographic area. ... Good Samaritan laws in the United States and Canada are laws protecting from blame those who choose to aid others who are injured or ill. ...

References

Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 179th day of the year (180th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 179th day of the year (180th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 166th day of the year (167th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 166th day of the year (167th in leap years) in the Gregorian calendar. ...

See Also

Defibrillation Typical view of the defibrillator operator. ...

External links

Electronics Portal

• American Red Cross: Saving a Life is as Easy as A-E-D
• FDA Heart Health Online: Automated External Defibrillator (AED)
• Resuscitation Council (UK)