DEFIBRILLATION AND THE

AUTOMATIC EXTERNAL DEFIBRILLATOR

A GUIDE

Defibrillation and the AED, A guide

Revised February 2012

Page 1 of 22

Original document complied by Pat Standen, Grampians Trauma, Emergency & Critical Care
Coordinator
ACKNOWLEDGEMENTS
Sue Garner, Clinical Educator, Intensive Care/Coronary Care Unit, Ballarat Health Services,
Amber van Dreven, Clinical Educator, Emergency Department, Ballarat Health Services and
Geoff McCurdy, Director of Pharmacy, Ballarat Health Services for reviewing the original
document and providing their expert advice.
Thank you to Wendy Porteous, Clinical Educator Emergency Department, Ballarat Health
Services for reviewing and revising this version 2012
Ballarat Health Services and Ambulance Victoria for so generously allowing their clinical
practice guidelines to be used as a guide.

For information regarding this Guide contact:

Pat Standen
Department of Health
PO Box 712
Ballarat 3353
Email: pat.standen@health.vic.gov.au
Phone: 03 5333 6026

Version
1.0
1.1

Date
September 2005
January 2008

2.0

February 2012

Major Changes

Page No

Basic Life Support Flowchart

AED Flowchart
Competency Assessment form
Basic Life Support Table
Section 3
Basic life support flowchart

16
17
18
20
11-19
20

DISCLAIMER:
Care has been taken to confirm the accuracy of the information presented in this guide, however, the authors, editors
and publisher are not responsible for errors or omissions or for any consequences from application of the information
in the guide and make no warranty, express or implied, with respect to the contents of the publication.
Every effort has been made to ensure the clinical information provided is in accordance with current
recommendations and practice. However, in view of ongoing research, changes in government regulations and the
flow of other information, the information is provided on the basis that all persons undertake responsibility for
assessing the relevance and accuracy of its content.

Defibrillation and the AED, A guide

Revised February 2012

Page 2 of 22

TABLE OF CONTENTS

Page
INTRODUCTION

SECTION 1
BRIEF REVIEW OF THE HEART
1.1
Anatomy
1.2
Coronary Arteries
1.3
The Conduction System

5
5
6
8

SECTION 2
THE ELECTROCARDIAGRAM
2.1
ECG Complex
2.2
ECG Grid Paper

9
9
10

SECTION 3
CARDIAC RHYTHMS AND DEFIBRILLATION
3.1
What is Defibrillation
3.2
Types of AEDs
3.3
Sequence of actions when using the AED
3.4
Position of Pads
3.5
Pads
3.6
Rhythms:
Ventricular Tachycardia
Ventricular Fibrillation
3.7
Defibrillation Safety
3.8
Procedure
Basic Life Support Flowchart

16
17
18
18
20

REFERENCES

21

SUGGESTED FURTHER READING

21

Defibrillation and the AED, A guide

Revised February 2012

11
11
11
12
12
15

Page 3 of 22

INTRODUCTION
The purpose of this guide is to assist educators in the Grampians Region to design their own
Health Service specific package for Registered Nurses Division 1, and others, required to use
an Automatic External Defibrillator (AED). There are a number of these devices available for
purchase; the aim of this guide is to provide generic information based on principles of care.
It is the responsibility of each individual practitioner and Health Service to ensure appropriate
education for all equipment and that competency in the use of the equipment is maintained.
The use and education around the AED should be undertaken in conjunction with Basic Life
Support (BLS) and Laryngeal Mask Airway (LMA) management.

Please note:
Any person wishing to use this material must review the materials prior to use and ensure
they are suitable for the purpose, including the needs of educators and intended training
recipients. Some aspects of the materials may not be relevant.
The accuracy and appropriateness of the materials may not suit all circumstances, and the
materials may not include all the information required.
Any person using the materials does so at their own risk and shall accept responsibility for
any actions arising from their use. No responsibility is taken for failure to update the materials
and it is the responsibility of the person to ensure that the information contained in the
materials is up to date and reflects current practice, law and guidelines.

Defibrillation and the AED, A guide

Revised February 2012

Page 4 of 22

SECTION 1

1.0

A BRIEF REVIEW OF THE HEART

1.1

Anatomy

Approximately the size of a persons fist, the heart weighs between 250 and 300grams. It sits
within the mediastinum and extends from the second rib to the fifth intercostal space. It
assumes an oblique position in the thorax; approximately two-thirds of its mass is left of the
midsternal line with the balance projecting right. The broad superior portion is approximately
9cms wide and is directed towards the right shoulder. The pointed apex is directed towards
the left hip and rests on the diaphragm.
The heart consists of four chambers, two atria and two ventricles. There is a valve through
which blood passes before leaving each chamber of the heart. The valves prevent the
backward flow of blood. These valves are actual flaps that are located on each end of the two
ventricles. They act as one-way inlets of blood on one side of a ventricle and one-way outlets
of blood on the other side of a ventricle. Each valve actually has three flaps, except the mitral
valve, which has two flaps. The four heart valves include the following:
Tricuspid valve: located between the right atrium and the right ventricle
Pulmonary valve: located between the right ventricle and the pulmonary artery
Mitral valve: located between the left atrium and the left ventricle
Aortic valve: located between the left ventricle and the aorta

http://housemedicalcenter.com/wp-content/uploads/2011/05/interion-view-of-the-heart.gif

Defibrillation and the AED, A guide

Revised February 2012

Page 5 of 22

1.2

Coronary Arteries

Coronary arteries supply blood to the heart muscle. Like all other tissues in the body, the
heart muscle needs oxygen-rich blood to function. The coronary arteries consist of two main
arteries: the right and left coronary arteries, and their two branches, the circumflex artery
and the left anterior descending artery.

http://www.cumc.columbia.edu/dept/rehab/images/Pages%20from%20cardiac-4_img_0.jpg

The left coronary artery (LCA), divides into the left anterior descending artery and the
circumflex branch, and supplies blood to the ventricles and left atrium.
The right coronary artery (RCA), divides into the right posterior descending artery and
a large marginal branch, supplies the ventricles, right atrium, and sinoatrial node.
The circumflex artery (Cx) branches off the left coronary artery and encircles the heart
muscle. This artery supplies blood to the back of the heart.
The left anterior descending artery (LAD) branches off the left coronary artery and
supplies blood to the front of the heart

Defibrillation and the AED, A guide

Revised February 2012

Page 6 of 22

Coronary
Artery:
Right

Left

Area and Structures Supplied:

Complications resulting from

occlusion:

Inferior wall of left ventricle

Sinus node (55% of individuals)
AV node (90% of individuals)
Bundle of His (90% of individuals)
Posterior inferior division of left bundle
(a portion)
Vagus nerve fibres
Right bundle branch (superior onethird)

Inferior STEMI, Posterior STEMI

and/or Right Ventricular STEMI
Conduction blocks First degree heart block
Second degree Type I and
Type II heart block
Third degree heart block
Bradyarrhythmias
Hypotension

Anterior wall of left ventricle (LAD)

Posterior wall of left ventricle (LCX)
Sinus node (45% of patients) (LCX)
AV node (10% of patients) (LCX)
Right bundle branch (inferior twothirds)
Anterior superior division of left
bundle branch
Posterior inferior division of left bundle
branch (a portion)

Anterior STEMI
Heart failure
Tachyarrhythmias associated with
heart failure
Conduction blocks Right bundle branch block
Left anterior hemiblock
Left posterior hemiblock
First degree heart block
Second degree Type II
Third degree heart block

LAD: Left anterior descending artery

LCX: Left circumflex artery

Defibrillation and the AED, A guide

Potential aneurysm formation

VT/VF

Revised February 2012

Page 7 of 22

1.3

The Conduction system:

http://4.bp.blogspot.com/_zb7BqrrxGWI/Swf5PAAep6I/AAAAAAAAAIs/tT_Va89y4io/s1600/Cardiac+conduction.gif

The ability of the heart muscle to depolarise is intrinsic. About 1% of the cardiac muscle fibres
become auto-rhythmic: they repeatedly and rhythmically generate action potentials. These
auto-rhythmic fibres serve two functions; the pacemaker, setting the rhythm for the entire
heart and the conduction system, the route for depolarisation to occur.

Sinoatrial (SA) node located in the right atrial wall inferior to the opening of the
inferior vena cava the normal pacemaker of the heart rate approx 70 80 per minute
(sinus rhythm). The wave of depolarisation spreads through the two atria and ends up
at the AV node.

Atrioventricular (AV) node located in the septum between the two atria. The impulse
from the SA node is delayed for about 0.1 sec at the AV node to allow the atria to
complete their contraction. The impulse then travels rapidly through the AV bundle
(Bundle of His) and enters both the right and left bundle branches. The pacemaker rate
of the AV node is 40 50.

Bundle branches right and left, course through the interventricular septum towards
the apex of the heart.

Purkinje fibres because the left ventricle is larger than the right the Purkinje network
is greater on the left. Conduction occurs at the apex of the ventricular myocardium first
then travels upward. Approx O.20 secs after the atria contract the ventricles contract.
The pacemaker rate is approx 20 40.

Defibrillation and the AED, A guide

Revised February 2012

Page 8 of 22

SECTION 2

2.0

THE ELECTROCARDIOGRAPH

2.1

E.C.G. Complex

P WAVE The first wave represents depolarisation of the atria. The impulse usually comes from the SA
node, which is the chief pacemaker of the heart and is situated in the right atrium. The
general wave of depolarisation is downwards and towards the left hand side of the body.
The P wave is generally not higher (amplitude) than 2-3mm and no longer than 0.10 0.11
of a second in duration. It is normally upright in Lead I, Lead II, aVF, V3 V6. It may be
inverted in aVR, may be biphasic in V1 and V2, and may be occasionally inverted in Leads I
and II and aVL.
PR INTERVAL
This interval represents the time taken for the impulse to go through the atria, across the AV
node and junction and down the Bundle of His. It is measured from the beginning of the P
wave to the beginning of the QRS. Normal duration 0.12 0.20 seconds.
QRS
This complex follows the P wave, PR interval and represents the depolarisation of the
ventricles. Depolarisation comes through the AV node, then goes through the septum and
then through the left and right ventricles. The general wave is downwards and to the left of
the body.
The QRS is usually 0.04 0.10 of a second in duration and between 5mm and 125mm in
amplitude, depending on the lead.
The Q wave is the first downward deflection preceding the R or S wave. If there is
no R wave it is termed a QS wave. The Q wave is normally less than 0.04 seconds in
duration, and less than a of the R wave. Q waves in Lead III and aVF may vary
with inspiration.
The R wave first upward deflection of the QRS complex usually less than 0.01
second in duration. The R wave in V6 represents left ventricle activity. The R wave in
V1 represents right ventricle activity.
The S wave first downward deflection following R wave is rarely deeper than
6mm and may be absent. An S wave in V1 represents left ventricle activity. An S
wave in V6 represents right ventricle activity.
ST SEGMENT
This segment represents the refractory period of the ventricles. The point where the QRS
joins the ST segment is called the J point.
The ST segment duration varies with the cardiac rate and ranges from zero to 0.15 seconds.
It is normally iso-electric (on the baseline) because positive and negative forces are equal
during this period.
T WAVE
This usually starts at the iso-electric line and varies in shape.
It represents rapid
repolarisation of the ventricles. Its amplitude is usually from 5mm 10mm.
It can be
upright in Lead I, Lead II, V3 to V6 inverted in aVR and variable in other leads.
Following the T wave a U wave of low voltage is sometimes seen, it may represent the slow
repolarisation of the ventricles. It is usually difficult to see.

Defibrillation and the AED, A guide

Revised February 2012

Page 9 of 22

 QT INTERVAL
This interval measures the total time taken for depolarisation and repolarisation of the
ventricle. It is measured from start of the QRS to end of the T wave. Its duration varies with
age, sex and cardiac rate, but usually is about 0.35 0.42 seconds. As a general rule QT
should be less then of the R R interval.
2.2

ECG Grid Paper

http://yenoh93.medceu.com/images/sample6.jpg

Measurements of paper and the complex:

P wave 0.20 sec
PR interval 0.12 0.20 sec
QRS interval 0.07 0.10 sec
ST segment measurement not significant, elevation or depression is more
important
QT segment measurement depending on heart rate
Calculation of Heart Rate
Paper speed: 25mm/sec therefore 5 large boxes = 25mm or 1 sec therefore 300boxes = 1
minute
If heart rate regular:
Measure the interval between the complexes (R R interval) and divide into 300
For example: 1 complex every large box = Rate 300bpm
1 complex every 2 large boxes = rate 150bpm
1 complex every 3 large boxes = rate 100bpm
1 complex every 4 large boxes = rate 75bpm
1 complex every 5 large boxes = rate 60bpm
OR
If the heart rate irregular:
15 large boxes = 3 secs therefore 30 large boxes = 6 secs
Count the complexes in a 6 second interval and multiply by 10 to get the rate per minute.

Defibrillation and the AED, A guide

Revised February 2012

Page 10 of 22

SECTION 3

3.0

CARDIAC RHYTHMS & DEFIBRILLATION

3.1

What Is Defibrillation?

The passage of an electrical current across the myocardium of sufficient magnitude to

depolarise a critical mass of myocardium, and enable restoration of coordinated electrical
activity
Source: Deakin et al (2010)
Mechanism of defibrillation
It is thought that successful defibrillation occurs when a critical mass of myocardium
is depolarised by the passage of an electric current (RCUK, 2011). This will then hopefully
enable the sinoatrial node (the hearts normal pacemaker) or another intrinsic pacemaker to
regain control of the heartbeat (Jevon, 2009).
REMEMBER: EARLY DEFIBRILLATION PROVIDES THE BEST CHANCE OF SURVIVAL IN
VF OR PULSELESS VT
Defibrillation refers to the current of electricity passing through the heart and it occurs at a
random point in the cardiac cycle (unsynchronised). Defibrillation produces simultaneous
depolarisation of the mass of myocardial cells and enables the resumption of organised
electrical activity.
3.2

Types of automated external defibrillator

AEDs are sophisticated, reliable, safe, computerised devices that deliver electric shocks
to victims of cardiac arrest when the ECG rhythm is one that is likely to respond to a
shock. Simplicity of operation is a key feature: controls are kept to a minimum, voice
and visual prompts guide rescuers. Modern AEDs are suitable for use by both lay
rescuers and healthcare professionals.
All AEDs analyse the victims ECG rhythm and determine the need for a shock. The
semi-automatic AED indicates the need for a shock, which is delivered by the operator,
while the fully automatic AED administers the shock without the need for intervention by
the operator. Some semi-automatic AEDs have the facility to enable the operator
(normally a healthcare professional) to override the device and deliver a shock
manually, independently of prompts.
Examples of some of the automatic external defibrillators available:

Welch Allyn AED 10

http://www.welchallyn.com/products/en-us/x-11-ac-100-0000000001041.htm

Defibrillation and the AED, A guide

Powerheart AED G3
http://www.powerheart.com/products/phaed_g3auto.htm

Revised February 2012

Page 11 of 22

Phillips HeartStart FR2

http://www.medical.philips.com/main/products/resuscitation/index2.html

3.3

Zoll AED
http://www.zoll.com.au/products/aed_plus/literature/AED_Plus_Brochure.pdf

Sequence of actions when using an automated external defibrillator

The following sequence applies to the use of both semi-automatic and automatic AEDs
in a victim who is found to be unconscious and not breathing normally.
1. Follow the adult BLS sequence. Do not delay starting CPR unless the AED is
available immediately.
2. As soon as the AED arrives:
If more than one rescuer is present, continue CPR while the AED is switched on. If
you are alone, stop CPR and switch on the AED.
Follow the voice / visual prompts.
Attach the electrode pads to the patients bare chest.
Ensure that nobody touches the victim while the AED is analysing the rhythm.
3A. If a shock is indicated:
Ensure that nobody touches the victim.
Push the shock button as directed (fully-automatic AEDs will deliver the
shock automatically).
Continue as directed by the voice / visual prompts.
Minimise, as far as possible, interruptions in chest compression.
3B. If no shock is indicated:
Resume CPR immediately using a ratio of 30 compressions to 2 rescue
breaths.
Continue as directed by the voice / visual prompts.
4. Continue to follow the AED prompts until:
qualified help arrives and takes over OR
the victim starts to show signs of regaining consciousness, such as
coughing, opening his eyes, speaking, or moving purposefully AND starts to
breathe normally OR
you become exhausted.
3.4

Position of Pads

The electrode positions are generally standard (you can refer to the instructions on your
AED). The apex pad is placed over the 6th intercostal space, anterior chest wall, mid axillary
line. The sternal pad is placed with its top in the 2nd intercostal space, just right of the
sternum.

Defibrillation and the AED, A guide

Revised February 2012

Page 12 of 22

http://www.lbfdtraining.com/Pages/emt/sectione/aed_files/image038.jpg

Female Electrode Pads Zoll One-Piece Pads

Female Electrode Pads Two Piece Pads Position

Defibrillation and the AED, A guide

Revised February 2012

Page 13 of 22

Male Electrode Pads Zoll One-Piece Pads

Male Electrode Pads Two Piece Pads Position

http://www.australiandefibrillators.com.au/use-an-aed.html

3.5

The Pads

The standard defibrillation pads for AEDs are about the size of your hand and are made of soft
thin foam coated on one side with a gel. The gel side is covered with a peel off backing which
is removed prior to placement on the chest. The backing is removed from one pad at a time
and the gel side firmly placed onto the patients bare chest (ensure moisture is wiped away
and the entire pad smoothed on firmly). Good pad contact will reduce the risk of skin burns
and reduce resistance to the current.

Defibrillation and the AED, A guide

Revised February 2012

Page 14 of 22

http://images-mediawiki-sites.thefullwiki.org/03/2/5/3/92649233828269596.jpg

Defibrillation if the victim is wet

As long as there is no direct contact between the user and the victim when the shock is
delivered, there is no direct pathway that the electricity can take that would cause the
user to experience a shock. Dry the victims chest so that the adhesive AED pads will
stick and take particular care to ensure that no one is touching the victim when a shock
is delivered.
Defibrillation in the presence of supplemental oxygen
There are no reports of fires caused by sparking where defibrillation was delivered using
adhesive pads. If supplemental oxygen is being delivered by a face mask, remove the
face mask and place it at least one metre away before delivering a shock. Do not allow
this to delay shock delivery.
Minimise interruptions in CPR
The importance of early, uninterrupted chest compressions is emphasised throughout
these guidelines. Interrupt CPR only when it is necessary to analyse the rhythm and
deliver a shock. When two rescuers are present, the rescuer operating the AED applies
the electrodes while the other continues CPR. The AED operator delivers a shock as
soon as the shock is advised, ensuring that no one is in contact with the victim.
CPR before defibrillation
Provide good quality CPR while the AED is brought to the scene. Continue CPR whilst
the AED is turned on, then follow the voice and visual prompts. Giving a specified
period of CPR, as a routine before rhythm analysis and shock delivery, is not
recommended.
3.6

Rhythms

There are four lethal rhythms

Ventricular Tachycardia (VT)
Ventricular Fibrillation (VF)
Pulseless Electrical Activity
Asystole
The two shockable rhythms, which the AED will recognise, are VT and VF. The AED reads the
ECG from the pads applied to the chest. Some AEDs have screens that show the rhythms,
some do not. The AED identifies the heart rhythms. The operator does not need to be able to
identify the rhythm or decide if there is a need for defibrillation. It is however useful to have a
basic knowledge of heart rhythms.

Defibrillation and the AED, A guide

Revised February 2012

Page 15 of 22

Ventricular Tachycardia
Rate variable from 140 to 250 beats per minute
P wave absent or obscured by the QRS
Ventricular rhythm usually regular but can be slightly irregular.
QRS complex wide and bizarre >0.12 seconds in duration.
Significance The rapid rate of this arrhythmia reduces ventricular filling time. Cardiac
output may drop due to the dissociation of atrial and ventricular activity. Patient is at risk of
cardiovascular collapse.
If patient unconscious, no signs of life
attach AED as soon as possible and follow the prompts
Causes include
Hypoxia
Electrolyte disturbances
Myocardial infarction
R on T phenomenon
Coronary artery disease
Treatment Treat as soon as possible, this rhythm is usually a precursor to VF. Treatment
may vary depending on whether there is a palpable pulse (often difficult to find) or patient is
conscious or unconscious.
Amiodarone
Potassium
Magnesium
Think Is there a pulse? Is the patient haemodynamically stable?
Rhythm strip Ventricular Tachycardia

(Diagnosis should be made from the rhythm strip or the viewer on the AED. An ECG is not
required to diagnose unconscious/pulseless VT)
ECG Ventricular Tachycardia

Defibrillation and the AED, A guide

Revised February 2012

Page 16 of 22

Ventricular Fibrillation
Rate indeterminate
P wave not visible
Ventricular rhythm chaotic irregular
QRS duration indiscernible
Significance With VF the ventricles quiver rather than contract, they fail to pump blood
and cardiac output falls to zero.
Causes include
Myocardial infarction
Untreated VT
R on T phenomenon
Electrolyte imbalance
Acid base imbalance
Electric shock
Hypothermia
Treatment Early defibrillation provides the best chance of survival in patients with VF or
pulseless VT.
Rhythm Strip Ventricular Fibrillation

(Diagnosis should be made from the rhythm strip or the viewer on the AED. An ECG is not
required to diagnose VF)
ECG Ventricular Fibrillation

Defibrillation and the AED, A guide

Revised February 2012

Page 17 of 22

3.7

Defibrillation Safety

Operators must be aware of the need for safety when using the AED.
Considerations include:
Adult pads cannot be cut down to a smaller size
There should be no contact with patient (by anyone) during defibrillation
Check pad area for jewellery, ECG electrodes, pacemaker (if pacemaker
present adjust pads) and medication patches
Think about conductive surfaces (water, fluids, metal)
Explosive environment (oxygen, gases, fumes)
Do not operate in an unstable environment which may prevent the AED from
performing a valid assessment of the ECG signal (eg. rapidly moving vehicle)
Respond to all prompts within safety constraints.
Make sure all personnel are clear of the patient during analysis and prior to
initiating a shock.
Cellular phones, radios or other devices that emit electrical signals may interfere
with the analysis of the AED and their use should be discouraged within 6 feet.
The use of AED in children (below 8yrs/40kgs) requires special pads. If the special
pads are not available, an unmodified adult AED may be used in children older
than 1 year
3.8

Procedure

Collapsed patient
Remember chain of survival

1. Call for help.

If you see someone collapse, immediately call for help and activate your emergency
procedures. If there are other people around, choose someone specific and instruct them to
call for help and explain the situation. This decreases confusion about who should do what
and ensures that the call is being placed.
2. Check the victim's breathing and airway.
If someone has collapsed, you should immediately determine whether they are breathing. If
the victim is breathing, you know that they have a pulse. If the victim is not breathing, check
the airway is clear then begin CPR at 30 chest compressions at a depth of 4-5cm then 2
breaths.
3. Locate an AED.
If there is an AED nearby, ask a bystander to take over CPR while you apply the AED chest
electrode pads to the victim. Uninterrupted CPR is an important factor in increasing the
recovery rate of cardiac arrest patients. Always ensure that someone is providing CPR for the
victim unless the AED is actively analysing or shocking the victim.
4. Turn on the AED.
Follow the visual & voice prompts of the AED

Defibrillation and the AED, A guide

Revised February 2012

Page 18 of 22

5. Attach the electrode pads to patients bare chest. (Expose the patients bare chest,
male or female)
First ensure that the adhesive AED pads are attached to a cable, which is plugged into the
AED machine. Then bare the victim's chest including females and attach the adhesive AED
pads in the appropriate locations. The AED should include a diagram (typically on the
adhesive pads themselves) indicating where each pad goes. The ZOLL AED uses a one-piece
chest pad that makes placement easy.
6. Always follow the instructions of the AED.
Note: CPR should not be interrupted while the adhesive electrode pads are being
applied.

Analysing the victims heart rhythm.

The AED may instruct you to Stop CPR, do not touch patient, analysing. The rescuer will
then say "CLEAR!" to ensure that nobody is touching the victim while the AED analyses the
victims heart rhythm. A shock is only indicated if the victim's heart is in ventricular fibrillation
(VF) or ventricular tachycardia (VT). The AED will automatically analyse the heart rhythm of
the victim and inform you, the rescuer, whether a shock is advised.
If you get a "no shock advised" instruction from the AED it can mean:
the victim that you thought was pulse less does indeed have a pulse, or
the victim has now regained a pulse, or
the victim is pulseless but is not in a 'shockable' rhythm
(i.e. not ventricular fibrillation (VT) or ventricular tachycardia (VT).
Follow the visual & voice prompts of the AED
Delivering a shock to the victim.
If the AED indicates that a shock is required, make sure that everyone is CLEAR of the
victim. Tell everyone assisting you to stay clear of the victim and ensure that you are clear of
the victim as well. Then press the shock button on the AED to deliver the first shock.
Immediately following the shock, begin 2 minutes of CPR as instructed by the AED.
Perform CPR in cycles of 30 chest compressions to 2 breaths for 2 mins or until the AED
informs you to "Stop CPR"
Note: Do not remove the AED chest pads while performing CPR.
Follow the visual & voice prompts of the AED
Check the victim's rhythm.
After 2 minutes the AED will say Stop CPR, analysing The AED is now analysing the victim to
see whether a shockable rhythm is present and instruct you again either Shock advised or
No Shock advised, continue CPR in intervals of 2 mins or until help arrives.
If the AED gives a "no shock advised" message after any analysis, check the victim's pulse
and breathing. If a pulse is present, monitor the victim's airway and provide assisted
breathing as needed.
Follow the visual & voice prompts of the AED

Defibrillation and the AED, A guide

Revised February 2012

Page 19 of 22

Defibrillation and the AED, A guide

Revised February 2012

Page 20 of 22

REFERENCES
Australian Resuscitation Council Guidelines, http://www.resus.org.au/
Deakin C et al (2010) European Resuscitation Council Guidelines for Resuscitation 2010.
Section 3. Electrical therapies: Automated external defibrillators, defibrillation, cardioversion
and pacing. Resuscitation; 81: 1293-1304.
Defibrillation and AED Use, Agilent Technologies
Defibrillation Training Course (Workbook), Surf Life Saving Australia (The life of the beach)
Version 2, December 2003
Tortora, G.T and Grabowski, S.R. 1996 Principles of Anatomy and Physiology 8th Ed. Sydney:
Harper Collins.
Jevon P (2009) Advanced Cardiac Life Support.
Oxford: Wiley Blackwell.
Resuscitation Council (UK) (2011) Immediate Life Support. London: RCUK.
http://medlib.med.utah.edu/kw/ecg/image_index/index.html#Vtachy
http://medlib.med.utah.edu/kw/ecg/index.html
http://www.cc.utah.edu/~mda9899/CPRTable.html
http://www.resus.org.uk/pages/aed.pdf

SUGGESTED FURTHER READING:

Kenward, G., Castle, N. and Hodgetts, T.J. 2002 Should ward nurses be using automatic
external defibrillators as first responders to improve the outcome from cardiac arrest? A
systematic review of the primary research. Resuscitation vol 52, issue 1, pp31-37
Resuscitation Council UK, The use of Automated External Defibrillators
http://www.resus.org.uk/pages/aed.pdf
Royal College of Nursing Australia 2006 Position Statement: The Role of Nurses in the
Management of Cardiorespiratory Arrest
http://www.rcna.org.au/UserFiles/role_of_nurses_in_the_management_of_cardio_respiratory
_arrest_revised_2006.pdf
Chan P et al (2008) Delayed time to defibrillation after in-hospital cardiac arrest. New England
Journal of Medicine; 358: 1, 9-17.
Deakin C et al (2010a) European Resuscitation Council Guidelines for Resuscitation 2010.
Section 4. Adult advanced life support. Resuscitation; 81: 1305-1352.
Deakin C et al (2010b) European Resuscitation Council Guidelines for Resuscitation 2010
Section 3. Electrical therapies: Automated external defibrillators, defibrillation, cardioversion
and pacing. Resuscitation; 81: 1293-1304.

Defibrillation and the AED, A guide

Revised February 2012

Page 21 of 22

Gwinnutt C et al (2000) Outcome after cardiac arrest in adults in UK hospitals: effect of the
1997 guidelines. Resuscitation; 47: 125-135.
Jevon P (2009) Advanced Cardiac Life Support. Oxford: Wiley Blackwell.
Resuscitation Council (UK) (2011) Immediate Life Support. London: RCUK.
Resuscitation Council (UK) (2010) Resuscitation Guidelines 2010. London: RCUK. tinyurl.com/
resus-2010-guidelines
Spearpoint KG et al (2000) Early defibrillation and the chain of survival in in-hospital adult
cardiac arrest: minutes count. Resuscitation; 44: 165-169.

Defibrillation and the AED, A guide

Revised February 2012

Page 22 of 22