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Published in Henry J. Woodford, Essential Geriatrics, 2022
Once an AED is commenced, it is rarely discontinued. However, there is evidence that having been seizure free for many years is associated with a lower risk of recurrence. A study of people who had been seizure-free for two years or more compared those who chose to attempt drug withdrawal to those who didn't (n = 611; median age 38).52 AED discontinuation was associated with a significantly increased risk of seizures when the person had been seizure-free for two to five years, but not for those seizure-free for more than five years. A randomised study of people seizure-free for more than two years compared AED withdrawal to continuation.53 Recurrent seizures occurred in 41% of people in the withdrawal and 22% in the continuation groups. People with shorter durations of epilepsy prior to remission, fewer total seizures and control with just a single AED are less likely to have seizure recurrence.54 Given the uncertainty of AED withdrawal, a shared decision-making process is required. Being a current vehicle driver favours drug continuation. Several years since the last seizure, uncertain epilepsy diagnosis or suspected drug adverse effects may favour discontinuation.
Neurologic disorders in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Robert Burger, Terry Rolan, David Lardizabal, Upinder Dhand, Aarti Sarwal, Pradeep Sahota
AED levels should be monitored closely in the weeks following delivery. During this period, AED levels may increase gradually. The increase in postpartum plasma levels of EIAEDs starts about 10 to 14 days postpartum. The levels of drugs that are excreted renally such as LEV, OXC, and LTG increase within days of delivery. Thus, some women require dose adjustment immediately following delivery.
Recognition and management of cardiopulmonary arrest
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
There are different types of defibrillator available in clinical practice: Manual defibrillators: these require a high level of rhythm recognition skills on the part of the operator but have the advantage, when used in expert hands, of reducing the delay in compressions to less than five seconds.Automated external defibrillators (AEDs): these are sophisticated computerised devices that can reliably analyse the heart rhythm and, through voice and visual prompts, guide you through safe defibrillation. In areas where staff may not have skills in rhythm recognition and/or do not use defibrillators regularly, training in the use of AEDs is achieved much more easily and quickly than in the use of manual defibrillators, and offers a way of achieving the goal of delivering the first shock within three minutes of collapse.
Association of GPS-Based Logging and Manual Confirmation of the First Responders’ Arrival Time in a Smartphone Alerting System: An Observational Study
Published in Prehospital Emergency Care, 2022
Julian Ganter, Jan-Steffen Pooth, Domagoj Damjanovic, Georg Trummer, Hans-Jörg Busch, Klemens Baldas, Daniel Schmitz, Michael P. Müller
When the dispatch center receives emergency calls with the indication “suspected cardiac arrest” or “unconscious person,” the SAS is activated automatically. The SAS system receives the geographical position, which represents the address of the emergency, and the estimated time enroute (ETE) of the closest EMS vehicle. The alerting radius for first responders is set by the SAS with the aim of activating first responders who have a chance of arriving prior to the ambulance. Registered first responders who are located within the alerting radius are activated via the SAS and are asked if they can accept the alarm. A maximum of four volunteers are selected by the system and receive details about the emergency (address and name of the patient). One of them receives the task of bringing a publicly available automated external defibrillator (AED) to the emergency location by navigating to the closest AED when there is one nearby. After the completion of a first responder alarm, the app asks every involved volunteer to fill out a questionnaire.
Are Irish Gaelic Athletic Association clubs prepared to use an AED following a sudden cardiac arrest? A cross-sectional survey
Published in The Physician and Sportsmedicine, 2020
Siobhán O’Connor, Enda Whyte, Lauren Fortington
Easy accessibility of an AED to facilitate early defibrillation is the greatest factor affecting SCA survival [11]. If bystander CPR and rapid defibrillation in public settings are in place between 3 and 5 mins following collapse, survival rates increase from 41% to 74% [11]. Therefore, it is critical that AEDs are not only available but also rapidly accessible. Thus, for sports clubs, members must be aware of AED presence, location, and how to access them in a medical emergency. From 267 respondents, approximately 60% reported their local club owns an AED. This proportion is reasonably consistent with previous research conducted with administrators of amateur clubs (mix of GAA, soccer, and rugby) in a region of Ireland, which reported 18.7% of clubs did not own an AED [12]. These results suggest wide availability of AEDs in Irish sport settings. While this a positive, there may be a tendency toward respondent bias, with those who know about AEDs keen to take part in the research. Formal documentation of AED location should be followed up in future research.
Automated External Defibrillator Shock Advisement Discordance Among Multiple Electrocardiographic Rhythms and Devices: A Preliminary Report
Published in Prehospital Emergency Care, 2019
Allison C. Koller, David D. Salcido, Georgia L. Lawrence, James J. Menegazzi
Defibrillators provide an essential means of correcting lethal arrhythmias through targeted electrical energy delivery to the myocardium. Early defibrillation is one of the only therapies strongly associated with survival from cardiac arrest when the presenting rhythm is a ventricular arrhythmia (1). Manual defibrillation entails trained operator review of the electrocardiogram (ECG) and subsequent confirmation of a shockable rhythm. Automated external defibrillators (AEDs) offload the task of rhythm identification to a computerized signal analysis system, requiring less training and giving rise to their integration into BLS emergency medical services practice, public access defibrillation programs, and CPR training courses over the past two decades (2). AED rhythm determinations can also play a role in termination of resuscitation decisions wherein an AED determination of “No Shock Advised” can influence the decision to discontinue care (3).