Collapsed Patient, AED, and the Handoff
At 14:05, Officer Patel is dispatched to a grocery store for a 62-year-old man who collapsed in aisle 4. She arrives in three minutes; EMS is six minutes away. A bystander is doing chest compressions, but they are shallow and at about 80 per minute. The man is unresponsive, not breathing, and has no pulse. An AED is mounted on the wall 30 feet away; a second officer is securing the scene and moving shoppers back. The man has a pacemaker scar on his upper chest and a nitroglycerin bottle in his pocket. The floor is tile, and there is enough room to work. Patel has completed CPR/AED training but has not used an AED in an actual resuscitation. She must decide the immediate sequence, what to do about the pacemaker and the nitroglycerin, and how to hand off care when EMS arrives.
1. What is the immediate BLS and AED sequence?
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Confirm scene safety and that the man is unresponsive, not breathing normally, and has no pulse. Have the bystander stop, then start high-quality compressions: center of the chest, at least 2 inches deep, 100-120 per minute, full recoil, minimal interruptions. If a second trained responder is available, provide bag-valve-mask ventilations at 30:2; if not, continue compression-only CPR. Switch compressors about every two minutes. Send someone for the AED, attach pads, clear everyone, and shock if advised. Resume compressions immediately after the shock or if no shock is advised. Do not stop to check the pulse repeatedly. The AED should be used as soon as it arrives; the pacemaker scar does not change the need for defibrillation.
2. What special considerations apply because of the pacemaker and nitroglycerin?
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For the pacemaker, avoid placing an AED pad directly over the device if an alternative placement is quick and feasible; use anterior-lateral or anterior-posterior placement and keep the pads several inches from the generator. Do not delay a needed shock for a long time to reposition pads. The device may produce a small movement or artifact, but it does not make defibrillation unsafe.
Nitroglycerin is not given to an unresponsive person with no pulse; it is for awake patients with chest pain under protocol. Do not put anything in his mouth. The bottle is useful information for EMS and may suggest cardiac history. Check for a medical alert bracelet and note the pacemaker scar. Do not let these details distract from compressions and early defibrillation.
3. How should Patel hand off and document the resuscitation?
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Give EMS a structured handoff: time of collapse, time CPR started, who performed it, compression quality, AED application times, number of shocks and whether the rhythm was shockable, any return of spontaneous circulation, medications, pacemaker, nitroglycerin bottle, and the patient's condition at transfer. Include the bystander's name and contact if possible. Document in the report: dispatch and arrival times, initial assessment, interventions in sequence, AED data download, and witness statements. Do not speculate about the cause. Preserve the AED recording and the store video.
After the call, complete the agency's medical-device and use-of-force/medical forms as required, restock the AED, and replace used pads and batteries. A defusing or peer support check is appropriate after a resuscitation, especially for an officer who has not used an AED in a real event. The documentation should be factual enough for medical quality review and any later legal proceeding.