Managing Cardiac Arrest: ECG Monitoring and Defibrillation

Introduction

In the event of a cardiac arrest, prompt action is crucial. Understanding the steps involved in ECG monitoring and defibrillation can help save lives.

Assessing the Patient

When a patient goes into cardiac arrest, follow these initial steps:

• Lay the Patient Back: Position the patient in a supine position.
• Check Responsiveness and Airway: Assess the patient's response and ensure their airway is clear.
• Confirm Cardiac Arrest: Verify that the patient is in cardiac arrest.

Setting Up the Defibrillator

To prepare the defibrillator, follow these steps:

• Select Appropriate Pads: Choose pads based on the patient's size. Adult pads are indicated for adult patients, while smaller pads are used for children.
• Connect the Pads: Plug the pads into the defibrillator's cable, ensuring proper alignment.
• Apply the Pads: Remove the pads from their packaging and adhere them to the designated areas on the patient's chest according to the provided pictures.

Monitoring and Defibrillation

Proceed with monitoring and defibrillation:

• Verify Lead Connections: Confirm that the leads are securely connected to the defibrillator.
• Confirm Rhythm: Check the ECG screen for a sustainable rhythm. If a pulse is present, do not administer a shock.
• Initiate CPR: If there is no pulse, begin CPR by placing hands interlaced in the centre of the chest and compressing at a rate of 100-120 times per minute.
• Check Local Protocol: Follow the local protocol for manual defibrillation or automated external defibrillation (AED).
• Shockable Rhythm: If the rhythm is ventricular fibrillation (VF) or ventricular tachycardia (VT) without a pulse, administer a shock at the appropriate energy level.
• Non-Shockable Rhythm: For rhythms other than VF or VT without a pulse, continue CPR.
• AED Mode: If using an AED, attach the pads and follow the instructions displayed on the machine.

Continuing Resuscitation

Continue the cycle of compressions and defibrillations:

• CPR Cycle: Maintain proper chest compressions at a rate of 100-120 times per minute.
• Follow AED Instructions: If using an AED, follow the prompts for shocks and CPR cycles.
• Seek Additional Help: Call for additional assistance to ensure continuous resuscitation efforts.
• DNACPR Orders: Cease resuscitation attempts if a valid DNACPR (do not attempt cardiopulmonary resuscitation) order is present for the patient or if instructed by a doctor or if the patient's injuries are incompatible with life.

Conclusion

During a cardiac arrest, quick and decisive actions are necessary. Proper ECG monitoring, defibrillator setup, and adherence to local protocols can greatly improve patient outcomes. Remember to follow the appropriate steps and seek additional help when needed to provide the best chance of survival.