Life-Saving Device: Automated External Defibrillator (AED)
- Discover the life-saving capabilities of an automated external defibrillator (AED) in treating cardiac arrhythmias.
- Learn how AEDs are designed to be user-friendly, even for laypersons, and are taught in CPR classes.
- Understand the importance of prompt action and CPR in increasing the chance of survival during cardiac arrest.
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An automated external defibrillator (AED) is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of electrical therapy which stops the arrhythmia, allowing the heart to reestablish an effective rhythm. With simple audio and visual commands, AEDs are designed to be simple to use for the layperson, and the use of AEDs is taught in many first aid, certified first responder, and basic life support (BLS) level cardiopulmonary resuscitation (CPR) classes. An automated external defibrillator is used in cases of life-threatening cardiac arrhythmias which lead to cardiac arrest. The rhythms that the device will treat are usually limited to: 1.Pulseless Ventricular tachycardia (shortened to VT or V-Tach) 2.Ventricular fibrillation (shortened to VF or V-Fib) In each of these two types of shockable cardiac arrhythmia, the heart is electrically active, but in a dysfunctional pattern that does not allow it to pump and circulate blood. In ventricular tachycardia, the heart beats too fast to effectively pump blood. Ultimately, ventricular tachycardia leads to ventricular fibrillation. In ventricular fibrillation, the electrical activity of the heart becomes chaotic, preventing the ventricle from effectively pumping blood. The fibrillation in the heart decreases over time, and will eventually reach asystole. AEDs, like all defibrillators, are not designed to shock asystole ('flat line' patterns) as this will not have a positive clinical outcome. The asystolic patient only has a chance of survival if, through a combination of CPR and cardiac stimulant drugs, one of the shockable rhythms can be established, which makes it imperative for CPR to be carried out prior to the arrival of a defibrillator. Uncorrected, these cardiac conditions (ventricular tachycardia, ventricular fibrillation, asystole) rapidly lead to irreversible brain damage and death, once cardiac arrest takes place. After approximately three to five minutes in cardiac arrest, irreversible brain/tissue damage may begin to occur. For every minute that a person in cardiac arrest goes without being successfully treated (by defibrillation), the chance of survival decreases by 7 percent per minute in the first 3 minutes, and decreases by 10 percent per minute as time advances beyond ~3 minutes. AEDs are designed to be used by laypersons who ideally should have received AED training. However, sixth-grade students have been reported to begin defibrillation within 90 seconds, as opposed to a trained operator beginning within 67 seconds. This is in contrast to more sophisticated manual and semi-automatic defibrillators used by health professionals, which can act as a pacemaker if the heart rate is too slow (bradycardia) and perform other functions which require a skilled operator able to read electrocardiograms. Bras with a metal underwire and piercings on the torso must be removed before using the AED on someone to avoid interference. American TV show Mythbusters found evidence that use of a defibrillator on a woman wearing an underwire bra can lead to arcing or fire but only in unusual and unlikely circumstances. A study analyzed the effects of having AEDs immediately present during Chicago's Heart Start program over a two-year period. Of 22 individuals 18 were in a cardiac arrhythmia which AEDs can treat (Vfib or Vtach). Of these 18, 11 survived. Of these 11 patients, 6 were treated by bystanders with absolutely no previous training in AED use.
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以下のとおりお答えします。 （訳文） 自動化された外部除細動器（AED）は、患者の命にかかわる心室の細小繊維性不整脈（心臓振顫）および心室の頻脈を自動的に診断するポータブルな電子機器であり、細小繊維性不整の解除や効果的な心拍の復活により、不整脈を止めるような電気療法の応用を通じて患者を治療することができる。 視聴覚による簡単な指示によって、AEDsは、素人が簡単に使用できるように設計されており、多くの応急手当においてその冒頭でAEDsの使用法を教えてもらえるので、最初の対応や基本的なライフサポート（BLS）レベルの心肺蘇生法（CPR）クラスが保証されている。 自動化された外部除細動器は、心臓停止を引き起こすような命にかかわる心臓不整脈の場合に使用される。通常、本機器が治療する心拍には、次の制限がある。 1. 無脈の心室頻脈（VT あるいは V-Tachと略記） 2. 細小繊維性不整脈／心臓振顫（VFあるいは V-Fibと略記） これら2種の衝撃性心臓不整脈の各々にあっては、心臓は電気的に活性化するけれども、それは血液の汲み上げと循環を許さないような機能障害のパターンである。心室頻脈では、心臓の鼓動が速すぎて血液を効果的に汲み上げることができないのだ。心室の頻脈は、最終的に心室の細小繊維の形成をもたらす。心室の細小繊維形成によって、心臓の電気的活動が無秩序となり、空洞が血液を効果的に汲み上げるのを阻止する。心臓の細小繊維形成は時間とともに減少し、結局は不全収縮に達する。 AEDsは、すべての除細動器同様、不全収縮／心拍停止（「平坦線」のパターン）についてはポジティブな臨床結果が出ていないので、これに衝撃を与えるように設計されてはいない。もし、不全収縮／心拍停止の患者に生き残りのチャンスがあるとすれば、それはわずかにCPRおよび心臓刺激性薬剤の組み合わせを通じて、衝撃性心拍のうちの1つなりを確定できる場合だけである。その際、除細動器の到着に先がけて、CPRの実施が必須である。 いったん心臓停止が起これば、これらの心臓の条件（心室の頻脈、心室の細小繊維形成、不全収縮）は、何らかの矯正がなされない限り、急速に遡及不可能な脳損害と死をもたらす。心臓停止から約3分ないし5分の後に、逆行不可能な脳／組織損害が起こり始める可能性がある。心臓停止の人が（除細動によって）首尾よく治療を受けることのないままで生き残るチャンスは分刻みで変化する。すなわち、最初の3分間では1分当り7％ずつ減少し、3分を越える時間帯では1分当り10％ずつ減少する。 AEDsは、十二分にAED訓練を受けた素人の人が使うように設計されている。けれども、訓練されたオペレータが67秒以内に除細動を開始するのに比べて、6年生なら90秒以内にそれをし始めるべきであるとの報告がなされてきた。これは、健康関係のプロによって使われるより洗練されたマニュアルや半自動除細動器と対比してのことであり、もし心臓の拍動率が遅すぎる（徐脈）ならば、それ（半自動除細動器）はペースメーカーとして作動したり、心電図の読み取りが可能な熟練したオペレータが要求されるような他の機能をも実行できる。 AEDを人に取りつける場合、金属のワイヤーの入ったブラや胴体部のピアスは、干渉を避けるため事前に取り除かれなければならない。アメリカのテレビショー“Mythbusters”（神話叩き）は、ワイヤー入りブラジャーを着ている女性に対する除細動器の使用は、発火につながることがあり得るという証拠を発見したけれども、ただしそれは異常な場合のみであり、ありそうもないような状況でのことである。 ある研究が、2年間にわたって「シカゴ心臓問題取組開始」プログラムでAEDsを設置して直ちに現れた効果を分析した。22人の個人のうち18人がAEDsで治療できる心臓の不整脈（VfibまたはVtach）であった。その18人中、11人が生き残った。これらの11人の患者のうち6人は、事前にAED使用の訓練経験のない部外者によって完全に治療された。
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関連するQ&A
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An Automated External Defibrillator is a simple to use device that uses computer technology to help a person whose heart has stopped heating. It analyzes the heart rhythm of a victim, and then advises the user whether a shock is required. AEDs are designed to be used by common people, who require little training to operate the devices correctly. AEDs are usually limited to just delivering shocks for VF(ventricular fibrillation) and VT(ventricular tachycardia) rhythms. There are 2 types of AEDs : Fully Automated and Semi Automated. Most AEDs are semi automated. A semi automated AED automatically diagnoses heart rhythms and determines if a shock is necessary. If a shock is advised, the person using the device must then push a button to give the shock. A fully automated AED automatically diagnoses the heart rhythm and advises the user to stand back while the shock is automatically given. Also, some types of AEDs come with advanced features, such as a manual override or an ECG display. In order to make them highly visible, public access AEDs are often brightly colored, and are mounted in protective cases near the entrance of buildings. When these protective cases are opened, and the defibrillator is removed, it might make an alarm sound to alert nearby staff that it has been removed. All trained AED operators should phone for an ambulance when sending for or using an AED. Because the patient will be unconscious, this always requires an ambulance to come.
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Automated external defibrillators are generally either held by trained personnel who will attend events or are public access units which can be found in places including corporate and government offices, shopping centres, airports, airplanes, restaurants, casinos, hotels, sports stadium, schools and universities, community centers, fitness centers, health clubs, theme parks, workplaces and any other location where people may congregate. The location of a public access AED should take into account where large groups of people gather, regardless of age or activity. Children as well as adults may fall victim to sudden cardiac arrest (SCA). In many areas, emergency vehicles are likely to carry AEDs, with some ambulances carrying an AED in addition to manual defibrillators. Police or fire vehicles often carry an AED for use by first responders. Some areas have dedicated community first responders, who are volunteers tasked with keeping an AED and taking it to any victims in their area. AEDs are also increasingly common on commercial airliners, cruise ships, and other transportation facilities. High-rise buildings are densely populated, but are more difficult to access by emergency crews facing heavy traffic and security barriers. It has been suggested that AEDs carried on elevators could save critical minutes for cardiac arrest victims, and reduce their deployment cost. In order to make them highly visible, public access AEDs are often brightly colored, and are mounted in protective cases near the entrance of a building. When these protective cases are opened or the defibrillator is removed, some will sound a buzzer to alert nearby staff to their removal, though this does not necessarily summon emergency services; trained AED operators should know to phone for an ambulance when sending for or using an AED. In September 2008, the International Liaison Committee on Resuscitation issued a 'universal AED sign' to be adopted throughout the world to indicate the presence of an AED, and this is shown on the right. A trend that is developing is the purchase of AEDs to be used in the home, particularly by those with known existing heart conditions. The number of devices in the community has grown as prices have fallen to affordable levels. There has been some concern among medical professionals that these home users do not necessarily have appropriate training, and many advocate the more widespread use of community responders, who can be appropriately trained and managed. Typically, an AED kit will contain a face shield for providing a barrier between patient and first aider during rescue breathing; a pair of nitrile rubber gloves; a pair of trauma shears for cutting through a patient's clothing to expose the chest; a small towel for wiping away any moisture on the chest, and a razor for shaving those with very hairy chests. Most manufacturers recommend checking the AED before every period of duty or on a regular basis for fixed units. Some units need to be switched on in order to perform a self check; other models have a self check system built in with a visible indicator.[citation needed] All manufacturers mark their electrode pads with an expiration date, and it is important to ensure that the pads are in date. This is usually marked on the outside of the pads. Some models are designed to make this date visible through a 'window', although others will require the opening of the case to find the date stamp.[citation needed] It is also important to ensure that the AED unit's batteries have not expired. The AED manufacturer will specify how often the batteries should be replaced. Each AED has a different recommended maintenance schedule outlined in the user manual. Common checkpoints on every checklist, however, also include a monthly check of the battery power by checking the green indicator light when powered on, condition and cleanliness of all cables and the unit, and check for the adequate supplies.
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Unlike regular defibrillators, an automated external defibrillator requires minimal training to use. It automatically diagnoses the heart rhythm and determines if a shock is needed. Automatic models will administer the shock without the user's command. Semi-automatic models will tell the user that a shock is needed, but the user must tell the machine to do so, usually by pressing a button. In most circumstances, the user cannot override a "no shock" advisory by an AED. Some AEDs may be used on children - those under 55 lbs (25 kg) in weight or under age 8. If a particular model of AED is approved for pediatric use, all that is required is the use of more appropriate pads. All AEDs approved for use in the United States use an electronic voice to prompt users through each step. Because the user of an AED may be hearing impaired, many AEDs now include visual prompts as well. Most units are designed for use by non-medical operators. Their ease of use has given rise to the notion of public access defibrillation (PAD), which experts agree has the potential to be the single greatest advance in the treatment of out-of-hospital cardiac arrest since the invention of CPR. Automated external defibrillators are now easy enough to use that most states in the United States include the "good faith" use of an AED by any person under Good Samaritan laws. "Good faith" protection under a Good Samaritan law means that a volunteer responder (not acting as a part of one's occupation) cannot be held civilly liable for the harm or death of a victim by providing improper or inadequate care, given that the harm or death was not intentional and the responder was acting within the limits of their training and in good faith. In the United States, Good Samaritan laws provide some protection for the use of AEDs by trained and untrained responders. AEDs create little liability if used correctly; NREMT-B and many state Emergency Medical Technician (EMT) training and many CPR classes incorporate or offer AED education as a part of their program. In addition to Good Samaritan laws, Ontario, Canada also has the "Chase McEachern Act (Heart Defibrillator Civil Liability), 2007 (Bill 171 – Subsection N)", passed in June, 2007, which protects individuals from liability for damages that may occur from their use of an AED to save someone's life at the immediate scene of an emergency unless damages are caused by gross negligence. Automated external defibrillators are under recent scrutiny by the U.S. Food and Drug Administration (FDA) which is now considering reclassifying AEDs as class III premarket approval devices. The major reason for this appears to be technical malfunctions, which likely contributed to more than 750 deaths in the 5-year period between 2004 and 2009, in most cases by component failures or design errors. During the same period, up to 70 types of AEDs have been recalled, including recalls from every AED manufacturer in the world.
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A crash cart is a cabinet containing equipment that physicians and nurses need when a cardiac arrest occurs (the heart stops beating). This is obviously a grave situation and requires immediate life-saving steps. These are some of the items found on a crash cart: Defibrillator - This is an electrical device with two paddles that are placed on your chest. It discharges electricity through your heart when a lethal rhythm is present. The goal is to shock the heart back to normal. "Lethal rhythms" include ventricular fibrillation (rapid, unsynchronized, uncoordinated heartbeat) and ventricular tachycardia (rapid heartbeat that prevents the heart from pumping properly). It can also be used in less dangerous rhythms to return the heart to a normal rhythm. Endotracheal intubation equipment - Endotracheal intubation is the procedure of placing a tube into someone's trachea (windpipe) when that person stops breathing or is not breathing adequately. The tube allows artificial respiration equipment to take over the job of breathing for the patient. The package includes tubes of different sizes and a laryngoscope -- a special light with a flat metal piece to lift the tongue out of the way so that a tube can be placed into the trachea. Central vein catheters - These are catheters (small tubes) placed in the large central veins (near the heart) so that medications and fluids can reach the heart and important organs quickly. •Cardiac drugs - During a cardiac arrest, certain potent drugs are required to restart the heart or return it to a more stable rhythm. The most common lethal arrhythmias present during a cardiac arrest are: •Ventricular fibrillation - Twitching of the ventricle (main chamber of the heart), as opposed to an effective contraction that pumps blood out of the heart •Ventricular Tachycardia - Rapid contraction of the ventricle, producing insufficient blood flow out of the heart •Asystole - Total absence of electrical activity and therefore no contraction of the heart •Pulseless electrical activity (PEA) - Electrical activity of the heart but inadequate contraction of the heart •Bradycardia - Various rhythms that cause the heart to beat so slowly that not enough blood is pumped out of the heart Some of the drugs that are used to treat these arrhythmias are: •Epinephrine - Used in ventricular fibrillation, pulseless ventricular tachycardia, asystole, PEA, and sometimes bradycardia •Atropine - Used in asystole, bradycardia and sometimes PEA •Lidocaine - Used in ventricular fibrillation and ventricular tachycardia There are many other pieces of equipment that are used in an emergency department, including the chest-tube tray, which holds the equipment needed to put in a chest tube (a tube placed between the ribs and the lung to re-expand a collapsed lung), and an ear, nose and throat tray, which holds specialized equipment used most commonly for nosebleeds and to remove foreign bodies from the ear, nose, or throat.
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An AED is "automatic" because of the unit's ability to autonomously analyse the patient's condition. To assist this, the vast majority of units have spoken prompts, and some may also have visual displays to instruct the user. "External" refers to the fact that the operator applies the electrode pads to the bare chest of the victim (as opposed to internal defibrillators, which have electrodes surgically implanted inside the body of a patient). When turned on or opened, the AED will instruct the user to connect the electrodes (pads) to the patient. Once the pads are attached, everyone should avoid touching the patient so as to avoid false readings by the unit. The pads allow the AED to examine the electrical output from the heart and determine if the patient is in a shockable rhythm (either ventricular fibrillation or ventricular tachycardia). If the device determines that a shock is warranted, it will use the battery to charge its internal capacitor in preparation to deliver the shock. This system is not only safer (charging only when required), but also allows for a faster delivery of the electric current. When charged, the device instructs the user to ensure no one is touching the patient and then to press a button to deliver the shock; human intervention is usually required to deliver the shock to the patient in order to avoid the possibility of accidental injury to another person (which can result from a responder or bystander touching the patient at the time of the shock). Depending on the manufacturer and particular model, after the shock is delivered most devices will analyze the patient and either instruct CPR to be given, or administer another shock. Many AED units have an 'event memory' which store the ECG of the patient along with details of the time the unit was activated and the number and strength of any shocks delivered. Some units also have voice recording abilities[citation needed] to monitor the actions taken by the personnel in order to ascertain if these had any impact on the survival outcome. All this recorded data can be either downloaded to a computer or printed out so that the providing organisation or responsible body is able to see the effectiveness of both CPR and defibrillation. Some AED units even provide feedback on the quality of the compressions provided by the rescuer. The first commercially available AEDs were all of a monophasic type, which gave a high-energy shock, up to 360 to 400 joules depending on the model. This caused increased cardiac injury and in some cases second and third-degree burns around the shock pad sites. Newer AEDs (manufactured after late 2003) have tended to utilise biphasic algorithms which give two sequential lower-energy shocks of 120 - 200 joules, with each shock moving in an opposite polarity between the pads. This lower-energy waveform has proven more effective in clinical tests, as well as offering a reduced rate of complications and reduced recovery time.
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Here we examine the relationship between the sun and climate by measuring the carbon-14 content in tree-rings with annual time resolution. The GCR flux and hence the activity level of the sun can be monitored by carbon-14. Our particular focus is around the period of the Maunder Minimum and the early Medieval Maximum Period (EMMP) in the 9–10th century. Sunspot numbers and the activity levels of the sun gradually change in time with quasi-cycles of about 11 years (Schwabe cycle).The polarity of the solar intrinsic magnetic field, which is more or less a simple dipole at every activity minima, reverses at every activity maximum. It changes the track of protons, the positively charged main constituent of GCRs, due to the spirally expanding interplanetary magnetic field formed by solar wind (Kota and Jokipii, 1983) and hence changes the attenuation level of GCRs in the heliosphere. Bulk of the GCRs comes from the polar region of the heliosphere when the polarity of the sun is positive, while GCRs come from the horizontal direction when negative.The attenuation of GCRs in the heliosphere is, therefore, more sensitive when the polarity is negative to the intensity of solar magnetic field and the tilt angle of the current sheets which expand horizontal direction. Thus the variation of the GCR flux on the earth has a “22-year” cyclic component, and will be transferred to the variations in carbon-14.
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The risk of accumulation of fissionable material in tanks, for which sub-criticality is not guaranteed only by the geometry shall be periodically reviewed by appropriate means after draining and rinsing, if any. 宜しくお願いします。
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When the tricky diagnosis of appendicitis is considered, blood tests and a urinalysis are required. The patient's blood is put into different colored tubes, each with its own additive depending on the test being performed: •A purple-top tube is used for a complete blood count (CBC). A CBC measures: 1) The adequacy of your red blood cells, to see if you are anemic. 2) The number and type of white blood cells (WBCs), to determine the presence of infection. 3) A platelet count (platelets are a blood component necessary for clotting) •A red-top tube is used to test the serum (the liquid or non-cellular half of your blood). •A blue-top tube is used to test your blood's clotting. The tests in your case indicate that you have an elevated WBC count. This is a sign of a bacterial infection, and bacterial infections are commonly associated with appendicitis. At this point, the emergency physician may request that you not eat or drink anything. The reason is that appendicitis is treated by surgery, and an empty stomach is desirable to prevent some complications of anesthesia. When the emergency physician has all the information he can obtain, he makes a determination of the most likely diagnosis from his differential diagnosis. Alternately, he may decide that he does not have enough information to make a decision and may require more tests. At this point, he speaks to a general surgeon -- the appropriate consultant in this case. The surgeon comes to see you and performs a thorough history, physical exam, and review of your lab data. She examines your symptoms: pain and tenderness in the right, lower abdomen, vomiting, low-grade fever and elevated WBC count. These symptoms all point to appendicitis. The treatment of appendicitis is removal of the appendix, or an appendectomy. The surgeon explains the procedure, including the risks and benefits. You then sign a consent form to document this and permit her to operate on you. The vast array of people caring for patients in an emergency department can be quite confusing to the average health care consumer -- as confusing as if you were watching your first baseball game ever and no one was around to explain all those players. Additionally, most people are uncertain of the training and background necessary to become a member of the emergency-department team. Well, here's the scorecard. The emergency physician comes to the team after spending four years in college studying hard to get as high a GPA (grade point average) as possible in order to get accepted into medical school. Medical school is a four-year course of study covering all the essentials of becoming a physician. It generally includes two years of classroom time, followed by two years rotating through all the different specialties of medicine. Toward the end of medical school, each medical student must select a particular specialty (emergency medicine, family practice, internal medicine, surgery, pediatrics, etc.). The medical student then completes an internship (one year) and residency (two to three additional years) in order to be a specialist in emergency medicine. Physicians must pass an all-day written exam and an all-day oral exam to become board certified in emergency medicine. As of 2001, there were approximately 32,000 emergency physicians practicing in the United States, of which 17,000 were certified by the American Board of Emergency Medicine.
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Climate change is often associated with extreme weather events, melting glaciers and rising sea levels. But it could also have a major impact on human, animal and plant health by making it easier for diseases to spread. Various germs and parasites may find the coming years a time to live longer and prosper. Rising temperatures are changing environments and removing some of their natural impediments. Sonia Altizer is an associate professor at the University of Georgia’s Odum School of Ecology and lead author of the study. She said it’s a review of research done over the past 10 years to see what trends and new information on climate change have emerged. “One of the big themes that has emerged is that there’s a lot of diseases, especially in natural systems, where there as a pretty clear signal that either the prevalence or severity of those diseases has increased in response to climate change.” She said some of those natural systems where the signal is strongest are in the arctic and in warmer oceans. “So in the arctic there are parasitic worms that affect muskox and reindeer, for example, that are developing faster and becoming more prevalent and expanding their ranges. And then in tropical oceans, like Caribbean coral reefs, there’s a large amount of evidence that has mounted that shows that warming interferes with the symbiosis of corals – makes them more vulnerable to disease and at the same time increases the growth rate of some lethal bacteria,” she said. But a second theme emerged indicating that sometimes climate change may have no effect at all. “The other main point that we focused on is that knowing why different pathogens respond differently to climate change is what’s needed to help us predict and ultimately manage disease outbreaks in people and animals and plants,” she said. Some countries will be much better prepared to handle the disease threat than others, like those in Europe and North America. . “Surveillance, vector control, modern sanitation, drugs, vaccines can be deployed to prevent outbreaks of a lot of diseases, especially vector borne disease or diarrheal disease that are much more problematic in the developing world. And so these can counter the effects of climate change and make it hard to detect increases in those pathogens,” said Altizer. Controlling vectors means controlling such things as mosquitos and ticks, which can carry malaria or dengue fever. In developing countries, pathogens affecting agriculture and wildlife could adversely affect food security and the livelihoods of indigenous peoples. So how concerned should health officials be? Altizer said there’s no simple answer. “I think that the answer to it really depends on the location. So where, when and what pathogen? So I think we’re at a stage now where in the next five to ten years scientists will be able to move towards a predictive framework that will be able to answer questions about where in the world and what pathogens are responding and will continue to respond most strongly to climate change.” Altizer says the effects of climate change will unfold over decades. So it’s vital to follow long-term standardized data for many diseases and pathogens. She said crop management may be a good example to follow. It has a long history of tracking disease outbreaks, forecasting potential threats and responding to those threats early.
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