NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5324

POLICIES AND PROCEDURES

Subject: Medical Direction

Associated Policies: 01/15/98

1. Therapeutic Effects:

1. Attempts to completely depolarize the myocardium and provide an opportunity for the natural pacemaker centers of the heart to resume normal activity.

2. Indications:

1. Ventricular fibrillation.
2. Pulseless Ventricular tachycardia.
3. Unstable ventricular tachycardia with a pulse.

3. Contraindications:

1. Absolute:

1. Asystole.

4. Equipment:

1. One (1) monitor/ defibrillator.
2. One (1) set defibrillation pads or conductive gel, or, one (1) set remote defibrillation patches. ( Fast patch if available.)
3. One (1) set infant pad adapters if not integral to device.

5. Procedure

1. Ensure that CPR has been initiated. If available assistance is limited, defibrillation takes precedence over CPR.
2. Attach fast patches or use paddles for "quick look" and evaluate the cardiac rhythm.
3. Use pediatric adapters for pediatrics less than 10 kg.
4. If "hands off" defibrillation is not used, place defibrillation pads or apply conductive gel to paddles.
5. Select appropriate energy level:

1. Adult: Start 200 J.
2. Pediatric: Use resuscitation tape, or start, 2 J/ kg.

1. Charge paddles.
2. Apply one paddle to the right of the upper sternum just below the right clavicle; the other, just to the left of the nipple in the midaxillary line.
3. Anterior posterior position may also be used. One paddle is positioned on the anterior chest over the heart and the other is positioned behind the heart on the back.
4. If pediatric paddles are unavailable and adult paddles are used, the anterior- posterior paddle position should be used.
5. Exert firm pressure.
6. Make sure no personnel are directly or indirectly in contact with the patient.
7. State and look to be sure area is clear.
8. Press both discharge buttons simultaneously to deliver shock.
9. Deliver the shock sequence as indicated by specific treatment protocol.