Emergency Equipments: AED and Emergency Ventilator: Usage, Pads, and Key Steps

OBJECTIVES
Upon completion of this lesson, you will be able to:

1. Define AED.
2. List 02 indications of AED.
3. List 8 P’s of AED check.
4. Describe two types of AED pads.
5. Demonstrate the use of AED.
6. Define ventilator.
7. Define tidal volume.
8. List 15 steps of Ventilator operation.
9. Demonstrate the use of micro ventilator.

1. AED (Automated External Defibrillator)

1.1 Definition
An automated external defibrillator that guides the rescuer through voice prompts and visual indicators and maintains a resuscitation sequence between defibrillation and Cardio Pulmonary Resuscitation.

1.2 Types of AED
These are many types of AED depending on the

• Weight
• Size
• Color

1.3 Indication
AED should only be applied when a patient is:

1. pulseless
2. breathless

1.4 8 P’s of AED check
Check for the Ps while applying an AED:

1. Pace maker
2. Perspiration
3. Pendants
4. Patches (nitroglycerin and nicotine)
5. Piercing
6. Playtex
7. Pregnancy
8. Pani (H2O)

1.5 AED Pads

The Zoll Plus AED supports three types of electrode Pads.

1. Adult stat-pads electrode
   • Used for adult patients.
2. Pedi Pads electrodes
   • Used for pediatric patients.
   • The AED automatically adjusts the defibrillation energy based on the type of electrode pads attached to it.
3. CPR D Pads electrodes
   • When the unit is used with CPR-D Pads it also monitors the rate and depth of chest compression.
   • It encourages the rescuers to perform chest compression at the recommended rate of hundred (100) compressions per minute and a depth of 2 inches.

1.6 Applying AED Pads

The AED monitors heart rhythm and delivers shock through pads. So the pads must be placed in a specific location.

• Adult Pad
  1st Pad: just below the patient’s right clavicle and to the right of the sternum.
  2nd Pad: over the patient’s left lower ribs or middle of axilla.
  • Most pads also have a placement diagram on them.
• Pediatric Pad
  1st Pad: between the nipples and on the sternum.
  2nd Pad: between the scapula.

1.7 Operating Guidelines

1. Check responsiveness.
2. Check CAB (Carotid, Airway, Breathing).
3. Perform CPR.
4. Put on AED after five cycles or after two minutes of CPR.
5. AED pads should be securely applied to the chest. This is not possible if the patient is extremely hairy.
6. Use a razor to remove the hair where pads are to be attached. If you do not have a razor, apply the pads.
7. If they are not in contact with the chest the AED will advise “check electrodes.” In response, remove the pads.

1.8 Components of AED

1. CASE
2. ON / OFF BUTTON
3. Indication lights
4. Voice prompts
5. Screen
6. Shock button
7. Analyse button (optional)
8. Pads with leads
9. Battery compartment

1.9 Voice Prompt by AED

1. Unit ok
2. Stay calm
3. Check responsiveness
4. Call for help
5. Open airway
6. Check breathing
7. Give two breaths
8. Plug in cable
9. Attach defibrillator pads to patient’s bare chest

(Adult pads/pediatric pads)

2. Emergency Ventilator

Definition

The emergency ventilator may be defined as any machine designed to mechanically move breathable air into and out of lungs.

2.1 Tidal Volume

The volume of air inhaled or exhaled at each breath. (See Table 1.1)

2.2 Operating Guidelines

1. Ensure personal safety & use proper protective equipment.
2. Set tidal volume (Vt) to respiratory frequency with ventilation setting regulator knob (see table 1.1).
3. Turn “ON” oxygen slowly, checking for any leakage.
4. Use mask/tube switch to set maximum ventilation pressure:
   • For Mask = 20 mBar
   • For Tracheal tube = 45 mBar
5. Perform head tilt, chin lift & attach mask to patient valve & place mask over patient mouth & nose. Use E-C technique to ensure the mask is sealed.
6. In case of tracheal tube, detach MEDU trigger & attach the patient valve to the tube.
7. The patient must be monitored during ventilation by checking ventilation pressure on pressure gauge. Turn “OFF” ventilator in case of any error or blinking of warning lights.

Demand Flow Mode

8. Turn the ventilation setting regulator knob to demand mode. A PEEP valve must not be installed in this mode.
9. Attach mask to patient valve & place mask over patient mouth & nose. Use E-C technique to ensure the mask is sealed.
10. Monitor patient & see pressure LED gauge, STOP in case of any error.

CPR Mode

11. Switch “ON” CPR mode by pressing CPR key.
12. Undertake 30 compressions with beep.
13. Hold MEDU trigger key until second ventilation stroke has begun.
14. At the end of resuscitation press CPR key to turn “OFF” CPR mode.
15. Clean, disinfect or sterilize ventilator & its components after each use. (See Table 1.2)

Table 1.1

Colour Code	Yellow	Orange	Brown
Age (years)	1-5	5-16	16+
Body weight (kg)	10-25	25-45	45
Respiratory frequency / min	25-15	15-12	12
Tidal volume (ml)	65-150	150-300	300

Table 1.2

Parts	Cleaning	Disinfection	Thermal Disinfector	Sterilization
MEDUMAT Easy CPR	With dry or damp cloth	Disinfect by wiping	Not permitted	Not permitted
Patient valve	In hot water with mild detergent	Immerse in dilute solution so that all surfaces, inside and out, are thoroughly wetted without bubbles. Wait until the full exposure time has elapsed. After disinfection, rinse all parts thoroughly inside and out with distilled water and leave to dry.	Cycle up to 95°C (thermal disinfection in an automatic cleaning machine)	Steam sterilization at 134°C in devices to EN 285, residence time at least 5–18 minutes.
Silicone ventilation mask
Ventilation hose
Hose casing, reusable	Wipe with a dry or damp cloth	Rinse cycle 30°C	Possible during cycle	Not permitted
Oxygen fittings	Wipe with a dry or damp cloth	Disinfect by wiping	Not permitted	Not permitted
MEDU trigger	Wipe with a dry or damp cloth	Disinfect by wiping	Not permitted	Not permitted

3. Surgical Equipment

1. Kelly Forceps

• Kelly forceps are a type of hemostat usually made of stainless steel.
• They also feature a locking mechanism to allow them to act as clamps. They may be either curved or straight.
• In surgery, they may be used for occluding blood vessels, manipulating tissues, or for assorted other purposes.

2. Needle Holder

• A needle holder is a surgical instrument, similar to a hemostat, used by doctors and surgeons to hold a suturing needle for closing wounds during suturing and surgical procedures.

3. Tooth Forceps

• A toothed forceps is a grasping instrument used to hold, reposition, or remove tissue and sutures during many medical procedures.

4. Surgical Scissor

• Surgical scissors are surgical instruments usually used for cutting.
• They include bandage scissors, dissecting scissors, iris scissors, operating scissors, and stitch scissors.

Conclusion

In conclusion, understanding the proper usage and guidelines for lifesaving devices like the Automated External Defibrillator (AED) and emergency ventilators is crucial for effective emergency response. The AED, designed to assist rescuers through voice prompts and visual indicators, can restore a normal heart rhythm in pulseless and breathless patients. Key aspects such as the 8 P’s check, proper pad placement for adults and pediatrics, and adherence to operating guidelines ensure its efficient use.

Emergency ventilators, vital in critical care, mechanically support breathing with carefully monitored tidal volumes and adjustable settings based on the patient’s age and weight. Following specific protocols, including the use of masks, tracheal tubes, and ventilation modes like demand flow and CPR, enhances their effectiveness. Cleaning and sterilization after every use ensure patient safety and device longevity.

The detailed instructions and operational checks for both AEDs and ventilators emphasize preparedness and precision in emergency scenarios. By familiarizing yourself with these life-saving tools, you can make informed decisions and take timely actions during critical situations. Always prioritize safety, adhere to protocols, and ensure all equipment is properly maintained and ready for use when needed. These measures can make the difference between life and death