Proficiency with Zoll in Manual Mode: There is a new Dashboard screen that you will see on the Zoll while in manual mode

Recognizing a shockable rhythm: Will be discussing the difference between course VF and fine VF and that if you are unsure if it is fine VF or asystole treated as asystole and do not shock Proficiency with Zoll in Manual Mode: There is a new Dashboard screen that you will see on the Zoll while in manual mode Cardiac arrest review: Review the link between manual defibrillation and hands off chest time as it relates to survival from out of hospital cardiac arrests.

Research conducted by Sunnybrook Center for Prehospital Medicine Medical Directors have demonstrated that reduced hands off chest time results in an increased survivability from out of hospital cardiac arrests. 4

Research conducted by Dr. Cheskes which has been published in Circulation has shown the more consistently chest compressions are done during any one minute time period (known as the chest compression fraction ) and the shorter the time is from stopping chest compression to delivering a shock (known as the preshock pause ) the better the chances are of survival. 6

This is a Zoll data file that shows the rhythm in the upper wave form and the CPR data along the bottom. Note the following: CPR is stopped at 18:43:34 for manual rhythm analysis and the shock is delivered 4 seconds later. 8

Note: Post pause time is extremely short at 2 seconds. The total time of chest to perform a manual analysis and deliver a shock is 6 seconds. Note that this is utilized the ready shock feature. 9

* The feature will start charging only after the first cycle of compression, which means that the first charge will have a traditional charge time and will require the compressor to stay on the chest during the charging phase. 10

Note: There are situations where the ready charge feature will not work: First initial charge If there is a hands off chest time > than 2 minutes (as seen sometime with prolonged movement/extrication of the patient with the pads disconnected) 11

This is one of the key reasons that we will be using manual defibrillation. This feature is only available in manual mode. This system uses at two button safety system arm the button! There are studies that have been done that show that it is safe to charge during CPR and that it reduces CPR hands off time. Safety and efficacy of defibrillator charging during ongoing chest compressions: A multicenter study Dana P.Edelsona,, BrianJ.Robertson Dickb, TrevorC.Yuena, JoarEilevstjønnc, DeborahWalsha, Charles J.Bareisd, TerryL.VandenHoeke, BenjaminS.Abellaf

PPI: A CPR feedback tool that give you an estimation of when maximum CPR effectiveness is reached. It will require approximately 20 compressions to fill the diamond and will rest every time there is a pause in CPR. Demonstrate to class how different pauses affect the diamond and reflect it on the perfusion pressure. Especially compare AED mode to manual mode with respect to the filling of the diamond

Key points: CPR metrics window rate of compression and depth. Colour will change if outside of recommended parameters. 2 minute countdown timer (this picture uses 1 minute) ours will be 2 minutes

Recommended: Have a Zoll monitor and demonstrate in front of the class step by step how to switch in to manual mode.

This video demonstrates the following Placing the Zoll into manual mode : note that once the monitor is placed into manual mode you do not have to scroll through the leads until you see PADS. It is now configured to go to pads when in manual mode and the pads are attached. Displays a filtered ECG it shows the underlying rhythm (VF) during CPR (electronically simulated only, it won t be this clear. CPR metrics (rate, depth, PPI) Note: the time it takes the PPI indicator to completely fill post shock New! CPR count down 2 minute timer Explain that this monitor has not been configured to display the ETC02 waveform, but it will replace the CPR bar graph on the dashboard

This will only happen until all paramedics are trained and the auto analysis in SAED mode is turned off. It is being left on until all paramedics have been trained o 19

Review with the class what ventricular fibrillation is and the treatment goals for it. 21

Discuss with the class that 22

When it is difficult to determine whether it is fine VF or Asystole it is important not to shock and consider it asystole. By not delaying CPR in order to study the rhythm, CPR may increase the coarseness of the VF leading to a greater potential of conversion. 23