D E F

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After ABC procedure is already stable, then the process proceed with DEF in Advanced Cardiac Life Support.

D - defibrillator, drugs
E - electrocardiography (ECG)
F - fluids

For the complete algorithm of BLS and Pulseless arrest algorithm - the use of shockable (defibrillator) and non-shockable, view the image below:

 BLS adult algorithm

Pulseless Arrest Algorithm

How to used Defibrillator?


1. Turn on defibrillator by select the energy level at 360J for monophasic, or 120J to 200J for biphasic.

2. Set lead select switch on paddles

3. Apply gels to paddles or position conductor pads on patient's chest

4. Position the paddles on patients (sternum-apex)

5. Check the monitor and assess the rhythm (ventricular fibrillation (VF) / ventricular tachycardia (VT) / asystole / pulseless electrical activity (PEA) )

6. Announce to the team members 'charging defibrillator'

7. Press 'charge' button on the paddles.

8. When it is fully charges, shout out before each shock:
- I going to shock in three. One I'm clear
- Two, you're clear
- Three everybody is clear.
*make sure no one is touching the patients, bed or any equipment like ventilator, IVs, oxygen tube etc

9. If paddles are used, apply 25 pounds of pressure

10. Press 'shock' button

11. Immediately resume CPR, begin with compressions, 5 cycles then re-shock (if possible)

References:
1. Skills lab manual on Advanced Cardiac Life Support.