Bzzzzztttttt......KERPOW!!!

[applepie]

thanks this was a very interesting thread, picked up alot of things here. gonna have a chat with a few mates since i didnt 100% understand everything.

i like the elephant song thing, never heard of that before! beats counting. will try it out in my next first aid refresher next month.

[dlegros]

Feel free to ask anything you want via PM and I'll do my best to answer.

[Mirk]

Just as a note of caution its important to follow the advice suppiled by the defib manufacturer with regard to amount of energy delivered, as different machines use different waveforms and different energy sequences some escalate and others don't. For example monophasic (older machines) should use 360j whilst other biphasic defibs vary from 120- 360j. As stated 150j non escalating is one of the most commonly applied relating mainly to phillips machines (whic is what we use in our trust). If you use a fully automated Defib (AED) then the machine wil select the correct energy for you

Also you must follow manufacturers advice whether the machines can be used in wet circumstances (and also metal floors). For example Phillips who manufacture the Heartstart Forerunner defibs advise that thier biphasic waveform is SAFE to use when the casualty is lying on wet or metal surfaces. However it is imperative that you prepare the chest by drying the area well, and also shave if necessary, avoid pacemaker sites, jewelry, and medication patches. Its also important that any oxygen is removed and that noone is actually touching the patient. Phillips state that the energy follows the path of least resistance which in the case of defib pads means from pad to pad IF proper preparation of the skin has taken place. If you are unsure as to what the manufacturer has advised (the majority of circumsatnces) then you should not be using the machine in areas where you as the operator canot absolutely guarantee safety, (wet, metal, or other areas where there s a risk of explosion) NONE of these machines are intrinsically safe therfore a risk of spark should be assumed!!

The key to succesful resucitation is quality CPR, partcularly compressions, and defibrillation as soon as appropriate (if appropriate in Ventricluar fibrillation, and Pulseless Ventricular tachycardia)

The current way we teach CPR to lay people is to follow ABC as stated before, but the ABC now stands for Airway, Breathing, CPR or Compressions (BHF 2006)

I'm back in work tomorrow and will post the info from phillips regarding safety in wet areas etc if anyone is interested. Hope all the above makes sense!

Mark

[dlegros]

Whilst my discussion of energy was indeed for Philips units, as you point out for a lay-rescuer it is immaterial as AEDs do not allow energy selection anyway.

Those of us on the board who are ALS/ILS trained will be working under local protocols as to energy selection anyway.

[paramedic paul]

Our Defibs are AED but I'm told we are moving back to manual systems in the near future giving us total responsibility for delivered shocks, this will be of great use when dealing with paediatrics!

Mark, I for one will be very interested in the Philips info regarding "wet" use!

[Mirk]

Sorry didnt have chance at work today will get it tomorrow

Mark

[dlegros]

Originally Posted by Mirk

Sorry didnt have chance at work today will get it tomorrow

Mark

No worries, looking forward to seeing it though.

[Mirk]

Here it is I've had to scan it but if anyone wants the official PDF then let me know. (PDF too big to post)

hope thats helpful

Mark

[Fee]

One of my favorite things about TV (and why I don't watch any medical drama except for "Bodies" which rocked!) is the flatline

all over the country doctors shout at the TV "the leads have come off!!" - cos that's what a flatline is.
Also remember - before ABC comes personal safety , so its not just "faffing around with clothing etc". luckily not generally an issue in hospitals (except for last year when one of my patients accidently disconnected himself from his temporary pacemaker whilst having a pee in a bottle, which then spilt all over him and the bed.
Cue me and 3 nurses in 20 seconds of headless chicken action....
"quick, get him back on the bed"
"oh darn, hes covered in his own urine; could someone towel him off please"
etc until we realised that he'd pulled the leads out of his pacing box and when we replaced them it all started working again - phew

[recurve]

Or the poor bugger that comes into a&e with a malfunctioning defibrillating pacemaker!

owwww.........................................bu** er................................ouch.......
stoppit...............................b**tard..... .............................