The History of Defibrillation

defibrillation

A defibrillator is a device that sends electrical energy, or shock, to the heart. The aim of using a defibrillator is to treat cardiac arrest. The need for this generally arises when the patient has ventricular fibrillation or ventricular tachycardia, which are life-threatening arrhythmias that occur when contraction of the ventricles become abnormal. Defibrillators have electrocardiogram (ECG) leads and adhesive patches (or paddles). The adhesive electrodes are the patches placed on the patient’s chest that deliver the electric shock.

The History of Defibrillation

In 1899, two physiologists from the University of Geneva, Jean Louis Prevost and Frederic Batelli, discovered that small electric shocks could cause ventricular fibrillation in dogs. Later, in 1933, a device was invented to send an electric shock to the heart as a substitute for administering cardiac medications.

In 1947, the first defibrillation was carried out by Claude Beck who was a professor of surgery at Case Western Reserve University. The defibrillator he used had internal paddles that were placed on each side of the heart.

Before the end of the 1950s, defibrillation was successfully performed only when the chest cavity of the patient was open during the surgery. In this case, the defibrillator had electrodes in the shape of paddles so that flat ends could be placed on either side of the exposed heart.

As the 1950s gradually came to an end, the closed-chest defibrillator device was invented. One of the basic differences between the open and closed-chest devices was that the closed-chest defibrillators required more voltage for operation. It was invented by Dr. V. Eskin and A. Klomov.

Thus far, the defibrillators in existence used alternating current. In 1959, Bernard Lown began to develop new ideas to make the device more energy efficient. Lown’s work led to the discovery of Direct Current (DC). Further development lead to the Biphase Truncated Exponential (BTE) waveform. With the BTE waveform, the defibrillators could use lower energy levels, which reduced the weight of the defibrillators that were later manufactured.

In the 1960s, Professor Frank Pantridge of Belfast began to introduce portable defibrillators for hospitals. This invention is now one of the most important tools that emergency medical services carry to resusitate people that suffer cardiac arrest. Portable units set forth the production of automatic defibrillators—devices with the ability to analyze heart rhythms.

The biphasic waveform did not completely replace the Lown waveform until the end of the 1980s. The waveform allowed defibrillators to work more quickly than the previous types. This in turn reduced the energy level needed for defibrillation. The success rate for treating cardiac arrest also improved.

In 1969, the research for making implantable cardioverter-defibrillator (ICD) began as a result of needing to provide adequate health care for victims of cardiac arrest. In 1980, the first implantable device was used at John Hopkins Hospital by Dr. Levi Watkins. Today, frequent victims of cardiac arrest are given the device for their aid at any time.

Types of Defibrillators

There are different kinds of defibrillators in use today. They include the manual external defibrillator, manual internal defibrillator, automated external defibrillator (AED), implantable cardioverter-defibrillator (ICD), and wearable cardiac defibrillator.

  • Manual external defibrillator: These defibrillators require more experience and training to effectively handle them. Hence, they are only common in hospitals and a few ambulances where capable hands are present. In conjuntion with an ECG, the trained provider determines the cardiac rhythm and then manually determines the voltage and timing of the shock—through external paddles—to the patient’s chest.
  • Manual internal defibrillator: The manual internal defibrillators use internal paddles to send the electric shock directly to the heart. They are used on open chests, so they are only common in the operating room. It was invented after 1959.
  • Automated external defibrillator (AED): These are defibrillators that use computer technology, thereby making it easy to analyze the heart’s rhythm and effectively determine if the rhythm is shockable. They can be found in medical facilities, government offices, airports, hotels, sports stadiums, and schools.
  • Implantable cardioverter-defibrillator: Another name for this is automatic internal cardiac defibrillator (AICD). They constantly monitor the patient’s heart, similar to a pacemaker, and can detect ventricular fibrillation, ventricular tachycardia, supraventricular tachycardia, and atrial fibrillation. When an abnormal rhythm is detected, the device automatically determines the voltage of the shock to restore cardiac function.
  • Wearable cardiac defibrillator: Further research was done on the AICD to bring forth the wearable cardiac defibrillator, which is a portable external defibrillator generally indicated for patients who are not in an immediate need for an AICD. This device is capable of monitoring the patient 24-hours-a-day. It is only functional when it is worn and sends a shock to the heart whenever it is needed. However, it is scarce in the market today.

When Not to Use a Defibrillator

Defibrillation is not indicated if the heart rhythm has completely stopped, as in asystole, or sometimes called “flat line,” or has pulseless electrical activity (PEA). Also, defibrillation is not indicated if the patient is conscious or has a pulse. Inappropriately given electrical shocks can cause dangerous arrhythmias, such as ventricular fibrillation.

Although defibrillators have specific indications and were initially exclusive to trained professionals, it is now possible to have one at home. Modern defibrillators are easy to use and do not require years of experience. In fact, a few tips from a health-care professional and a review of the the manual is all that may be needed to correctly intervene in a cardiac emergency. This development is helpful in reducing the number of death rates caused by sudden cardiac arrest and other heartbeat-related problems each year.

FALLS THROUGH SKYLIGHTS AND PLASTIC ROOF SHEETING

FALLS THROUGH SKYLIGHTS AND PLASTIC ROOF SHEETING

Safety Alert |

This safety alert reminds persons of the risks associated with working on roofs with skylights or plastic roof sheeting, as well as the actions required to ensure those risks are eliminated or minimised.

BACKGROUND

In March 2018, one worker died and two others received serious injuries, including fractures and spinal injuries, after falling through a skylight or plastic roof sheeting.

These incidents demonstrate that it is not just exposed edges that create the risk of a fall when working on roofs.

KEY CONSIDERATIONS

Not all areas on a roof are safe to walk on or step or fall onto if you stumble or lose balance.

Even plastic sheeting that is claimed to be trafficable can become brittle over time and is highly reliant on correct installation to be trafficable.

When on existing roofs, dirt and algal growth can make it harder to notice plastic sheeting, especially if it has the same profile as the surrounding sheeting.

Roof sheeting profiles, surface changes, dirt, moisture and obstructions on roofs make it more likely that a person will stumble and deviate from their intended travel path.

ACTION REQUIRED

Before commencing work on an existing roof, carry out an inspection to determine:

  • the presence and condition of sky lights, plastic roof sheeting and other brittle roof sheeting such as asbestos cement sheeting
  • the presence and integrity of safety mesh.

Whether it’s an existing structure or one under construction, consider skylights and plastic roof sheeting as non-trafficable areas unless certified as trafficable. Even then, ensure that the installation has been checked and proven to comply with trafficable installation instructions. Note: cut down sheets may need additional fixings and even a missing screw can make a sheet non-trafficable.

Where non-trafficable, provide appropriate fall prevention/protection measures and develop work methods to prevent people from stepping or falling onto non-trafficable surfaces.

To ensure the necessary control measures are being applied as the work progresses, an ongoing review of the work should also be carried out.

MEASURES FOR CONTROLLING THE RISK

Control measures to prevent a person from falling through a fragile roof or skylight include, but are not limited to:

  • plan the work to avoid accessing non-trafficable areas
  • work from a solid construction to avoid standing on the roof itself
  • install temporary work platforms (crawling boards) and roof ladders as appropriate
  • install barriers, such as guard rails or covers, that are secured and labelled with warning signs
  • install safety mesh
  • install a fall arrest system (harness) which has adequately-installed anchorage points, along with training and instruction in the use.

FURTHER INFORMATION

Snake Bite

 

Snake Bite

Following teaching a First Aid course yesterday where we had a visit from a juvenile brown snake in the classroom, I thought it timely to remind everyone about Snake Bite treatment.

Australia has some 140 species of land snake, and around 32 species of sea snakes that have been recorded in Australian waters.

There are around 100 Australian snakes that are venomous, although only 12 are likely to inflict a wound that could kill you. These include Taipans, Brown snakes, Tiger snakes, Death Adders, Black snakes, Copperhead snakes, Rough Scaled snakes as well as some sea snakes.

Most snake bites happen when people try to kill or capture them. If you come across a snake, don’t panic. Back away to a safe distance and let it move away. Snakes often want to escape when disturbed.

All snake bites must be treated as potentially life-threatening. If you are bitten by a snake, call triple zero (000) for an ambulance.

Different types of snake bites

Dry Bites

A dry bite is when the snake strikes but no venom is released. Dry bites can be painful and may result in swelling and redness around the area of the bite. This occurs because you don’t look like something the snake wants to eat.

Because you can’t tell if the bite is a dry bite, always assume that you have been injected with venom and manage the bite as a medical emergency. Once medically assessed, there is usually no need for further treatment, such as with antivenoms. Many snake bites in Australia do not result in envenomation, and so they can be managed without antivenom.

Venomous Bites

Venomous bites are when the snake bites and releases venom (poison) into a wound. Snake venom contains poisons which are designed to stun, numb, or kill other animals.

Symptoms of a venomous bite include:

  • severe pain around the bite, this might come on later
  • swelling, bruising or bleeding from the bite
  • bite marks on the skin (these might be obvious puncture wounds or almost invisible small scratches)
  • swollen and tender glands in the armpit or groin of the limb that has been bitten
  • tingling, stinging, burning or abnormal feelings of the skin
  • feeling anxious
  • nausea or vomiting
  • dizziness
  • blurred vision
  • headache
  • breathing difficulties
  • problems swallowing
  • stomach pain
  • irregular heartbeat
  • muscle weakness
  • confusion
  • blood oozing from the site or gums
  • collapse
  • paralysis, coma or death

In Australia, there are around two deaths a year from venomous snake bites.

Snake identification

Identification of venomous snakes can be made from venom present on clothing or the skin using a so called ‘venom detection’ kit. For this reason, do not wash or suck the bite or discard clothing.

DO NOT attempt to kill the snake for purposes of identification, as medical services do not rely on visual identification of the snake species regardless.

Antivenom is available for all venomous Australian snake bites.

First aid for snake bites

For all snake bites, provide emergency care including cardiopulmonary resuscitation (CPR) if needed. Call triple zero (000) for an ambulance. Apply a pressure immobilisation bandage and keep the person calm and as still as possible until medical help arrives.

Avoid washing the bite area because any venom left on the skin can help identify the snake.

DO NOT apply a tourniquet, wash, cut or suck the venom.

Pressure immobilisation bandage

A pressure immobilisation bandage is recommended for anyone bitten by a venomous snake. This involves firmly bandaging the area of the body involved, such as the arm or leg, and keeping the person calm and still until medical help arrives.

Follow these steps to apply a bandage using the Pressure Immobilisation Technique (PIT):

  • Start at the bite itself, wrapping around it three (3) times. It should be tight, and you should be unable to slide a finger between the bandage and the skin. Then continue down the limb till the very tips of the fingers are showing. Continue back up the limb until reaching the armpit or groin. Splint the limb including joints on either side of the bite.
  • Keep the person and the limb completely at rest. Mark the site of the bite with a coin over the bite prior to bandaging or write a cross on the bandage with a pen and the time of envenomation.

Anaphylaxis

Snake bites can be quite painful. Occasionally some people have a severe allergic reaction (anaphylaxis) to being bitten. In this case, the whole body can react within minutes which can lead to anaphylactic shock. Anaphylactic shock is very serious and can be fatal.

Symptoms may include:

  • difficulty talking
  • difficulty swallowing
  • difficulty breathing or shortness of breath or wheezing
  • swelling of the mouth, throat or tongue
  • rash
  • itching – usually around your eyes, ears, lips, throat or roof of the mouth
  • flushing (feeling hot and red)
  • stomach cramps, nausea &/or vomiting
  • feeling weak
  • collapse or unconsciousness.

Call triple zero (000) from a landline or 112 from a mobile for an ambulance. If the person has a ‘personal action plan’ to manage a known severe allergy, they may need assistance in following their plan. This may include administering adrenaline to the person via an autoinjector (an Epipen®) if one is available.

Adapted from an article at www.healthsure.com.au

Can you claim your first aid course fee on your private health insurance?

Did you know that you may be able to make a private health insurance claim part for part, or all, of your first aid training course fee?

Depending on the fund, and the level of extras or packaged cover you have, your health insurer may pay for your first aid course. Check with your health insurer to see if this item is included.

Terms and conditions may apply. For example, the training must be nationally accredited, and must be provided by a government-accredited Registered Training Organisation (RTO). Your health insurer will be able to advise the full requirements.

It’s great to see that some health funds are recognising the importance of first aid training in your overall health management, and are acknowledging that a first aid course can contribute to the health maintenance of your family members.

If you are interested in obtaining a quote for group training, please email Fiona@thefirstaidlady.com.au or phone 0427 571 594.

Enjoy the beach but mind the stingers…

It’s great weather for enjoying the seashore on beaches across Australia, but the marine stingers think so too, particularly in Queensland.

The onshore northerlies on various beaches means blue-bottles aplenty. Some beachgoers have said it’s the worst summer they can remember for these stinging ocean dwellers, with a huge number of people reported being stung between 20 December and 10 January on beaches across.

The bluebottle – Physalia utriculus – is commonly referred to as a type jellyfish; however, it is not a ‘true’ jellyfish. Bluebottles float on the top of the water where they are blown by the wind. The poisonous tentacles hanging below the float are armed with stinging cells called nematocysts that inject venom into their prey (fish and other small marine life), and into unsuspecting swimmers.

For humans, the sting is painful but not deadly, and the pain starts to fade after about half an hour, especially if treatment begins promptly. However, children, asthmatics, and people with allergies can be badly affected, some experiencing respiratory distress.

The most effective treatment recommended these days is hot water. But first, remove the tentacles by picking them off with tweezers or gloved fingers, and rinsing the affected area with seawater. Then immerse the area in hot water. Ice can also be used to help with the pain. Rubbing with sand or applying vinegar are not recommended as they may aggravate the sting.

A rarer and more dangerous marine stinger is the Morbakka fenneri, a member of the Irukandji family. A sting from this creature can result in Irukandji syndrome. Symptoms include severe lower back pain, nausea and vomiting, difficulty breathing, profuse sweating, severe cramps and spasms, and a feeling of impending doom.

In this case, because the creature is classed as a tropical stinger, vinegar is the recommended treatment. Vinegar neutralises the discharge mechanism of the stinging cells, making them instantly and permanently unable to discharge any further venom.

First aid priorities are:

  •  Call 000 or the lifeguard
  • Apply CPR if necessary
  • Flood the sting area with vinegar
  • Seek further medical help if required

However, reports of stings are rare, and hospitals across the country are well-equipped to deal with victims of Irukandji syndrome.

To be safe in the sea, always swim between the flags, heed any warnings of the presence of marine stingers.

A range of first aid, workplace health and safety, and construction and industry courses are available from Allens Training’s extensive partner network of more than 500 qualified trainers across Australia.

If you would like to book into a course and learn the appropriate first aid response for treating stings, you should book into a first aid course.

If you are interested in obtaining a quote for group training, please email Fiona@thefirstaidlady.com.auor phone 0427 571 594. 

Four reasons you should update your first aid or CPR certificate

If it has been more than a year since you last completed first aid or CPR training you are likely due to renew at least the CPR component of your certificate.

Why should you keep your certificate current? Well, beyond various workplace and employment requirements, it is always good to refresh your first aid and CPR skills for a number of reasons.

I have forgotten what to do…

If, over the past 12 months, you haven’t had to use the skills you learned in you last first aid course, you may have forgotten some of what you learnt. It’s as simple as out of sight, out of mind.

As with most things, it’s always good to refresh your skills regularly, so when you need to use them you are confident to do so.

Things change…

As with all things, first aid treatments change over time. For example, over time the treatment for snake bites has changed, as has best practice CPR.

You could save someone you love…

I think we are all guilty of saying ‘I should do a first aid course one day’, but the reality is, unless we need to certificate for another reason such as work, we never actually attend a course.

Now is the time to stop procrastinating. Emergencies can happen anytime, anywhere. Whether you are grocery shopping at the local IGA, or at the park with your children, you could be required to perform CPR or first aid. Wouldn’t you want to know what to do?

You need it for work…

Does your workplace have a first aid officer? The First Aid in the Workplace Code of Practice recommends that first aiders should attend training on a regular basis to refresh their first aid knowledge and skills, and to confirm their competence to provide first aid.

Alternatively, you could be on the look-out for a new job, or about to complete a placement for your nursing degree at the University of the Newcastle (UoN).

Stop wasting time and act now.

If you haven’t done training in the last year, it is probably time to refresh your CPR skills. You can book into HLTAID001 Provide Cardio Pulmonary Resuscitation to refresh your skills and renew the knowledge required to perform Cardiopulmonary Resuscitation (CPR) in line with the Australian Resuscitation Council Guidelines.

And how long has it been since you did a first aid course? Act now and book into your next HLTAID003 Provide First Aid course to learn all the necessary skills and knowledge required to provide first aid responses, life support, and management of casualties, the incident and other first aiders, until the arrival of medical or other assistance.

By refreshing your first aid training, you ensure your skills are up-to-date with the latest knowledge and treatments methods.

A range of first aid, workplace health and safety, and construction and industry courses are available from Allens Training’s extensive partner network of more than 500 qualified trainers across Australia.

If you would like to book into a course and learn the appropriate first aid response for treating stings, you should book into a first aid course.

If you are interested in obtaining a quote for group training, please email Fiona@thefirstaidlady.com.au or phone 0427 571 594.

Pin It on Pinterest

Share This
X