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An automatic external defibrillator (AED) device with or without manual control option is useful in smaller clinics and urgent care centers where the cost and maintenance of a larger fully manual device may be prohibitive.
A manual defibrillator device, which usually has manual control options, may have the option to also function automatically as an AED.
The newer defibrillator devices (such as Life Pack 12) include pads rather than paddles, which may also be used for cardiac pacing.
Unstable supraventricular tachycardia with a pulse. In the absence of a pulse, unsynchronized cardioversion is performed.
Patient with serious signs or symptoms due to arrhythmia including
Acute coronary syndrome.
Decreased level of consciousness.
Unstable atrial fibrillation with acute presentation.
New onset atrial fibrillation, if known to have begun within the past 48 hours:
Note that when attempting to restore sinus rhythm in a patient with atrial fibrillation, the presence or absence of an atrial clot must be determined. It is often recommended that patients undergo cardiac echo to determine the absence of an atrial clot, which may embolize after conversion to sinus rhythm.
Ventricular tachycardia with a pulse that is not responsive to pharmacologic therapy.
Used in cardiac arrhythmias of ventricular origin without a palpable pulse:
Atrial tachycardias that do not respond to cardioversion: [comp: nested
Multifocal atrial tachycardia, which is usually a supraventricular tachycardia with an irregular rhythm and is not usually responsive to cardioversion
Sinus tachycardia, which is a response to underlying pathology (shock, pulmonary embolus, etc.) and not a primary rhythm disturbance
Patients with little proven symptomatic improvement with sinus rhythm
Left atrial diameter >4.5 cm (relative)
Patients who have a low probability of maintaining sinus rhythm and readily return to atrial fibrillation (relative)
Patients who require a pacemaker for maintenance of stable rhythm after cardioversion such as patients with sick sinus syndrome or sinoatrial (SA) nodal blockade
Absence of electrocardiographic wave (QRS) complex on electrocardiogram (EKG) monitor
Pearl: A general procedure form with the benefits and risks of the procedure described is acceptable and must be signed by the patient or guardian, the provider, and a witness.
PITFALL: Skin burns can occur if inadequate gel is applied to the patient’s skin.
Pearl: Urgent cardioversion in the unstable patient may not allow time for sedation. If possible in the conscious patient, adequate sedation should be administered.
Return of oxygen saturation to baseline
Normal vital signs
Return of level of consiousness to baseline
Return of baseline ambulatory capacity
Emergency Medical Technology, Inc.; 1721 SE Grace, Suite 123, Battle Ground, WA 98604. Phone: 360-667-0368. Web site: http://emergencymedicaltechnology.com/lifepak500aed.html.
Philips HeartStart Defibrillators; Philips Medical Systems, N.A., 22100 Bothell Everett Highway, P.O. Box 3003, Bothell, WA 98041-3003. Phone: 1-800-722-7900. Web site: http://www.medical.philips.com/main/products/resuscitation/index.html.
Foremost Equipment, 320 N. Washington Street, Rochester, NY 14625. Phone: 585-586-4880. Web site: http://www.foremostequipment.com/Home/tabid/36/Default.aspx.
AED Professional, General Medical Devices Company, 411 Colfax Street, Palatine IL 60078. Phone: 1-888-541-2337. Web site: http://www.aedprofessionals.com/.