The automated external defibrillator
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7425.1216 (Published 20 November 2003) Cite this as: BMJ 2003;327:1216All rapid responses
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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
Ships Doctor
P&O / Princess Cruises
Competing interests:
None declared
Competing interests: No competing interests
Editor,
The author states¡¦....."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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
A Picture is Worth a Thousand Words
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
Competing interests: No competing interests