Introduction
The Heartstream FR2 defibrillator is a semi-Automated
External Defibrillator (AED). It is compact, lightweight, portable and battery
powered. It is designed for simple and reliable operation and is intended for
use by personnel who have been trained in Basic Life Support (BLS) and in its
operation.
Functions of AED
When connected to defibrillator pads that a property applied
to the victim’s bare chest, an AED can:-
·
Analyze the heart rhythm of a victim in cardiac
arrest.
·
Recognize a shock able rhythm called Ventricular
Fibrillation (VF).
·
Advice the operator through voice prompts and
visual indicators whether or not the rhythm is shock able.
The defibrillation pads sense the cardiac electric signal
and send it to the computer and electrical shock is delivered through the
defibrillation pads if a shock is indicated.
It delivers 150 joules each shock, non-escalating in a
biphasic wave. Energy runs from left pad to right pad and again back to left
pad.
Sudden Cardiac Arrest
Sudden Cardiac Arrest (SCA), also
known as sudden cardiac death, is a major cause of death that claims many lives
each year due to Ventricular Fibrillation (VF).
Ventricular Fibrillation (VF) is
the most common abnormal heart rhythm that causes adult sudden cardiac arrest.
VF is a type of uncoordinated, chaotic electrical activity that can occur
within the heart for reasons such as
heart disease, drowning, asphyxiation, electrical shock, poisoning or drug
overdose.
When the heart goes into VF, there is
a rapid and unproductive quivering of the heart muscle that prevents blood from
reaching the brain and other parts of the body. Death occurs within a few
minutes unless VF is stopped by defibrillation, which is the only effective
treatment.
Defibrillation means delivery of
electrical currents to the heart muscle through defibrillation pads adhered to
the patient’s chest and connected to a defibrillator. The therapeutic
electrical shock stops the VF momentarily, allowing the heart to pause and
enabling the heart to regain normal control of its rhythm to resume its normal
function.
Ventricular Fibrillation rapidly
deteriorates to an astolic rhythm (flat line on the heart monitor) typically in
5 – 6 minutes. The earlier the victim is defibrillated, the more likely the
victim’s life can be saved. Survival rates after VF cardiac arrest decrease 7%
to 10% with every minute that defibrillation is delayed. It is very important
to understand the time factor – that seconds count for the victim of SCA. The
AED must be made available at the victim’s side. If there is no VF present in
the cardiac arrest victim, defibrillation will not be required; however victim
must be given CPR to maintain blood circulation to the vital organs.
Maintaining The Chain of Survival
Activate the Chain of Survival
immediately when a person collapses. CPR is a vital link in the chain of
survival that must be initiated to support the victim until other, more
advanced support is available.
The 4 crucial links in the chain of
survival includes the following sequence:
1. Early Access
2. Early CPR
3. Early Defibrillation
4. Early Advanced Care
Begin the steps of DRABC as your priorities until the arrival
of AED to initiate the third link: Early Defibrillation.
Danger - Rule out danger to yourself
and victim. Ensure scene safety and personal
protection. Observe the Universal Precautions e.g. wear gloves, use the
Air-Viva resuscitator.
Response - Check responsiveness. If victim is unresponsive, call for help!
Bring the AED and other first aid equipment.
Bring the AED and other first aid equipment.
Airway - Open the airway. Perform head
tilt-chin lift or Jaw-thrust technique.
Breathing - Check for breathing. If victim
is not breathing normally give
2 slow rescue breaths.
2 slow rescue breaths.
Circulation - Look for signs of circulation
after the 2 rescue breaths. If no signs of
circulation, begin CPR and AED use. When two or more
rescuers are
present, integration of CPR and AED can be initiated
simultaneously.
Defibrillation - Use the AED
immediately when it is available. Early defibrillation
increases the victim’s chance of survival.
increases the victim’s chance of survival.
Patient Criteria
The AED is indicated or use on victim of sudden cardiac arrest
with all the following signs:
·
Unresponsiveness
·
Absence of breathing
·
Absence of circulation
NOTE: Victim
must be 8 years old or older. This is in accordance with the
recommendations
of the FDA and American Heart Association.
of the FDA and American Heart Association.
Contraindications
The AED should not
be used on victim who shows any of the following signs:
·
Responsiveness
·
Presence of breathing
·
Presence of circulation
Special
Consideration:
The AED may be used on a conscious
person for ECG monitoring upon request by trained medical personnel e.g.
doctor, paramedic and emergency room personnel when a passenger is suspected of
a serious heart condition.
Safety
Considerations In AED Use
Before attaching the AED, determine
whether special situations exist that contraindicate the use of AED or require
additional actions before its use.
1. Children
If
the victim is younger than 8 years old, do not use the AED due to high electric
energy setting. Standard operating procedures should be followed in treating
children over eight years of age.
2. Water
A good conductor of electricity and
may provide a pathway for energy from the AED to rescuers and bystanders
causing shock hazard.
·
Remove the victim from contact with water.
·
Dry the victim’s chest quickly before attaching
the AED.
·
Do not immerse or wet any portion of the AED in
water.
3. Metal Surface
·
Do not allow the defibrillation pads to touch
any metal surfaces to avoid possible shock hazard e.g. other ECG electrodes or
lead wires.
4. Transdermal
Medications
·
Do not place defibrillation pads directly on top
of medication patch as it may block
delivery of shocks or cause small burns
to the skin.
·
Remove the medication patches e.g.
nitro-glycerine, hormone replacement, nicotine etc and wipes the area clean
before attaching the AED pads.
5. Implanted Pacemakers or Defibrillators
Placement of an AED defibrillation
pad directly over an implanted medical device may reduce the effectiveness of
defibrillation attempts.
·
Place the defibrillation pad at least 1 inch
(2.5 cm) away from the implanted device.
Preparing The AED For Use
Installing
the Battery
There are 2 battery packs supplied
in the AED. One battery pack is ready installed for use at any time and the
other one is for standby (spare). Before installing the battery, make sure the
defibrillation pads are not connected to the AED. To install the battery:
1. Hold the battery pack by the yellow
latch end and slide it into the battery compartment at the top of the AED.
2. Slide the battery all the way into the
opening, until the yellow latch clicks into place. The latch will click into
place only when the battery is inserted correctly.
3. When the battery is installed, the AED
automatically turns on. The Status
Indicator displays a flashing black hourglass. The shock button light and
the indicator light for the defibrillation pads connector port turn on briefly.
Running the Battery Insertion Selftest
(BIT)
Except in an emergency. It is
recommended that this selftest is carried out every time the battery is changed
in order to make sure the display, buttons, lights, speaker and beeper of the
Heartstream FR2 are working properly.
To run the Battery Insertion Selftest (BIT):
1. Make sure that the defibrillation pads
are not connected to the device. If the pads are connected, the selftest will
stop immediately to allow the AED to be in the standby mode (ready for use).
2. Insert the battery into the battery
port. The first screen displayed RUN SELFTEST highlighted.
will start automatically.
4. When the interactive part of the
battery insertion selftest is completed, the FR2 AED automatically turns off
and returns to standby mode. The Status Indicator shows the flashing black
hourglass. The AED is ready for use at any time simply by pressing the On/Off
button to turn it on.
Periodic Selftests
In addition to the battery insertion
selftest, the AED automatically performs periodic selftests (PSTs). These
daily, weekly and extensive monthly selftests check many important functions of
the AED, including battery capacity and internal circuitry. If a problem is
detected, the Status Indicator will show a flashing red X or a solid red X and
the AED will beep to alert you to the need for troubleshooting.
The
4 Universal Steps of AED Operation
When you arrive with the AED at the
scene of a possible cardiac arrest, perform the following steps of AED
operation after you have verified that the victim is 8 years of age or older,
he or she is unresponsive, absence of breathing and circulation.
Step
1. POWER ON the AED first (in order to
get voice and visual guidance prompts).
· Open the carrying case of the AED.
·
Press the On/Off button to turn on the AED.
Follow the voice and screen prompts in the order indicated.
·
Always turn the AED ON as the first step. DO NOT
wait until you have opened the package of defibrillation pads or attached the
pads to the patient’s chest.
Step 2. APPLY defibrillation pads to the victim’s bare chest (stop chest
compressions just before attaching the pads).
Preparing
the Chest
·
Remove clothing and undergarments from the
victim’s chest.
·
Wipe moisture from the victim’s chest.
·
Shave excessive chest hair if necessary. Be sure
the chest is bare and dry so that the AED pads can stick firmly to give a good
contact for defibrillation.
Pads
Location.
·
Place each pad on the patient’s skin, one at a
time.
·
Pull off the protective backing from the
defibrillation pad and check that the gel has not dried out. If the pads are
damaged or the gel has dried out, use a new set of pads.
·
It is important to refer to the drawing on the
back of each pad for correct positioning.
·
One pad is attached just below the patient’s
right collarbone, above the nipple.
·
Another pad is over the patient’s ribs in line
with the armpit and below the left breast.
· Plug pads connector firmly to the connector
socket which is at the top left of the AED. A Flashing light shows you where
the socket is located.
SAFETY
WARNING
·
Do not place the two pads on the patient’s chest
and back.
·
Do not allow the defibrillation pads to touch
each other or other ECG electrodes, lead wires, dressing, chest piercing etc to
prevent skin burns and ineffective energy.
·
Air pocket between the skin and defibrillation
pads can cause skin burns. To help prevent air pockets, make sure the pads
completely adhere to the skin. Do not use dried-out defibrillation pads.
Step
3. ANALYZE Heart Rhythm
Voice
Prompt: ANALYZING! DO NOT TOUCH PATIENT!
As soon as the AED detects that the
defibrillation pads are connected properly, it automatically begins analyzing the
patient’s heart rhythm. To prevent incorrect heart rhythm analysis or delayed
diagnosis caused by interference:
·
Clear
the patient during analysis.
·
Check that
no one is touching the patient, including the person doing the rescue
breathing.
·
Avoid all movement affecting the patient during
rhythm analysis.
Analyzing continues and AED
displayed the patient’s ECG on the screen. Follow
the instructions provided by the AED voice and screen prompts in the order
indicated.
Step
4. SHOCK DELIVERY
If
a shock is advised: AED provides voice and screen prompts to tell you so.
The AED charges to prepare for shock
delivery. While it is charging, it continues to analyze the patient’s heart
rhythm. Make sure that no one is touching the patient. The shock button will be
flushing orange when it is charged up.
AED
prompts: “Press the SHOCK button now.”
The rescuer operating the AED should
clear the patient before pushing the SHOCK button. You must check visually and
verbally make sure that no one is touching the patient and refuse to push the
SHOCK buttons until all contact with the patient stops.
SHOUT:
“I AM CLEAR, YOU’RE CLEAR, EVERYBODY’S CLEAR”
·
It is important that you must press the button
for a shock to be delivered. The AED will not automatically deliver a shock.
After you have pressed the Shock button, a voice prompt tells you that the
shock was delivered.
·
If the Shock button is not pressed within 30
seconds of being prompted, the AED will disarm the current itself and goes back
to analyzing mode.
Following the first shock delivery,
the AED continues to analyze the patient’s heart rhythm to see if the first
shock was successful to treat the VF. The AED continues to provide voice and
text prompts to guide you through additional shock if needed.
Pause
for CPR. The AED is programmed to administer up to 3 shocks in a row if
needed. If the victim requires 3 shocks in a row and VF rhythm is still
present, you will hear the audio prompts: Pause! Check for signs of
circulation, if needed begin CPR. The AED automatically pause for 1 minute to
allow you to perform CPR to maintain blood circulation to the brain and heart.
During the pause, the AED screen
shows a bar that fills in as the pause time is used up. It also shows how many
shocks have been delivered and how much time has gone by since the AED was
turned on. The AED will resume analyzing at the end of the pause period and
advise to shock as needed.
If
no shock is advised: AED provides voice and screen prompts to tell you so.
·
AED prompts: No shock advised. It is safe to
touch the patient. Check for signs of circulation. If needed begin CPR.
·
Follow the AED prompts. Check for signs of
circulation. Observe for Heart Rate (HR) on the display screen. If the victim
is not breathing normally and has no signs of circulation, start CPR
immediately.
·
The voice prompts are repeated at interval of 1
minute while the AED is monitoring the patient. If there is no VF present, the
AED will not charge to shock.
·
If the AED detects a potentially shockable heart
rhythm (VF), it automatically goes back to Step 3 (Analyze Heart Rhythm) to see
if a shock is needed.
Care
of Victim After Successful Defibrillation:
·
Do not switch
of the AED or remove the pads. Leave AED turned “on” to monitor the victim.
·
If victim has a normal breathing and
circulation, put into the recovery position.
Administer oxygen. Monitor victim closely and record the vital signs. Be
prepared to shock again
·
Do not allow
the AED to be removed during transfer of patient, instead unplug only the
connector from the socket and leave the pads on the chest. Provide them a copy
of your observation chart.
After use, check the AED’s battery status and AED
pad availability. Keep it ready for emergency use at all times.
Status
Indicator Summary / Troubleshooting Guide
|
STATUS INDICATOR
|
RECOMMENDED ACTIONS DURING EMERGENCY
|
|
Flashing black hourglass
|
Ready for use. Follow the voice and screen prompts.
|
|
Flashing red X
Other Signal:
Audio signal: chirping
Possible cause:-
- Battery power is low.
- An error has been detected as part of
the selftest.
|
Continue to use the
AED in an emergency incident when there is no other AED available.
- Turn on the AED and follow the
voice and screen
Prompts.
Troubleshooting required:
- Remove and reinstall the same battery and run a
Battery insertion
selftest.
- If it fails, install a new battery and repeat the
selftest.
- Turn on AED and follow voice prompts.
|
|
Solid red X
Possible cause:-
The battery is completely depleted
or missing.
|
Do not use the AED.
Troubleshooting required:
- Remove and reinstall the same
battery.
- Run the battery insertion
selftest. If it fails, install
a new battery and repeat the selftest. Turn on
device and follow voice prompts.
- If the solid red X is still not
cleared, do not use
the AED.
|
|
None of the above
|
Check for visible damage. Do not
use if is appears to be damaged. However, if voice and screen prompts are
present, in an emergency incident, it
is recommended that you continue to use the AED.
|
Defibrillation Pads / Troubleshooting Guide
|
Screen / Voice
Prompts:
|
Possible Cause
|
Recommended Action
|
|
Voice prompts:
Press pads firmly to patient’s bare chest or
Poor pads contact
|
Pads are not making good contact
with the chest
|
- Make sure that the pads are
sticking completely to the
patient’s skin.
- Dry the chest or shave off
excessive chest hair if this
is the caused.
- If the prompts continues
after attempting the above,
replace the pads.
|
|
Replace Pads
|
The pads, cable or connector may
be damaged or defect
|
- Replace the defibrillation
pads with new one.
|
|
Plug in connector
or
Insert connector firmly
|
The pads connector is not firmly
inserted in the connector port
|
- Make sure the pads
connector is completely
inserted in the
connector port.
- If the prompts continues
after trying, replace the
defibrillation pads.
|