Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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AAED
- manan vasenwala md, mrcp (uk) (21 November 2003)
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Is 007 licensed to be killed?
- Phillip J. Colquitt (23 November 2003)
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Public Access Defibrillation and Community First Responders
- Roderick Mackenzie (23 November 2003)
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AEDs' some additional points
- Damian . P McAliskey (28 November 2003)
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A Picture is Worth a Thousand Words
- Gordon A. Ewy (19 December 2003)
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manan vasenwala md, mrcp (uk), consultant-cardiologist(non-invasive) k.k.heart center, aligarh-202002.india
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two modifications would make aed more useful. firstly the paddles should be strapable to the torso. a trigger mechanism should be incorporated between aed and defibrillator.the shock will therefore be delivered automatically. no need for voice prompts, which may not be audible in a crowd. in this way the machine can be made fully automatic if desired. lastly any contact with torso should ring an alarm for resucitation provider and temporarily inactivate the aed, sort of cut out. it will be thus be an aaed, all automatic external defibrillator. Competing interests: None declared |
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Phillip J. Colquitt, Technical Advisor Place of work: self-employed
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Editor, The author statesˇ¦....."It may be necessary to dry the chest if the patient has been sweating noticeably or shave hair from the chest in the area where the pads are applied. A sharp razor should be carried with the machine for this purpose."[1] I doubt that a disposable razor such as I have seen supplied with AEDs would be effective in removing "carpet chest" hair[eg. the Conery 007]. This means some sub-groups are disadvantaged. Is there any accumulated data to explore this aspect of AEDs? [1]Roy Liddle, C Sian Davies, Michael Colquhoun, and Anthony J Handley. The automated external defibrillator. BMJ 2003; 327: 1216-1218 Competing interests: None declared |
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Roderick Mackenzie, Clinical Research Fellow in Pre-hospital Imediate Care MAGPAS, 105 Needingworth Road, St Ives, Cambs, PE27 5BR
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Editor, The Clinical Review by Liddle and colleagues is timely. Automated External Defibrillators (AED) are becoming cheaper and more readily available. Whilst I appreciate that the focus of the review is on the AED itself, I would make a plea for clarity regarding the terminology surrounding their use. In particular, the terms Public Access Defibrillation (PAD) schemes and targeted community first responder schemes tend to be used almost synonymously. They are not the same. First responder schemes involve trained individuals who carry an AED and who are activated following a 999 call within their local area. PAD schemes involve placement of equipment in a public place (e.g. railway or shopping centre) and provision of focused training to staff members. There is, as far as I understand, no direct link to the 999 system. The distinction between the two is important and should be considered by all those considering the purchase of a defibrillator. The relative advantages of targeted community first responder schemes over PAD schemes have been discussed elsewhere.1,2 Roderick Mackenzie Medical Director MAGPAS Community First Responder Scheme for Cambridgeshire References 1. Pell JP, Sirel JM, Marsden AK, Ford I, Walker NL, Cobbe SM. Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study. BMJ 2002; 325: 515-517. 2. J P Pell. The debate on public place defibrillators: charged but shockingly ill informed. Heart 2003; 89: 1375 - 1376. Competing interests: MAGPAS funds, equips and manages the network of Community First Responder Schemes across Cambridgeshire |
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Damian . P McAliskey, Ships Doctor P&O / Princess Cruises International Limited C/O Medical Department, P&O Cruises, Richmond House,Terminus Terrace, Southampton, SO14 3PN
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Dear Editor, Whilst working as a ships’ doctor I have used AEDs’ at eleven cardiac arrests over the last four years and I feel that some additional points, associated with the use of this equipment, are worthy of mentioning. AEDs’ are battery powered devices and must be checked on a regular basis, usually weekly, to ensure ongoing adequate battery function. In addition to a disposable razor it is advisable to store an extra battery and a spare set of electrode pads with the AED. Generally speaking there is also adequate space within the AED transportation case for a large strong pair of scissors, to facilitate the removal of the patients clothing, and a Laerdal resuscitation mask to aid basic life support when the reposnder is trained in this technique. Damian McAliskey
Competing interests: None declared |
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Gordon A. Ewy, Professor & Chief of Cardiology, Director University of Arizona Sarver Heart Center University of Arizona College of Medicine, Tucson, Arizona 85724-5037
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In the very nice article "ABC of Resuscitation," the lateral electrode in the picture "The Automated External Defibrillator" (1), is positioned way too low. In the narrative, the authors correctly state that, "electrode is placed lateral to the left nipple with the top margin of the pad about 7 cm below the axilla." Seven centimeters is less than three finger breadths, and it is obvious that the lateral electrode placed to illustrate correct electrode position is not correct. The defibrillating current must pass through the fibrillating chambers to be effective. For ventricular fibrillation, a significant portion of the current must pass through the left ventricle. For educational purposes, I would suggest a different photo showing the electrodes in the corrrect position, e.g., with the left electrode higher in the left axilla and somewhat more posterior so that the defibrillating current passes through more of the left ventricle. Competing interests: None declared |
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