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  #1  
Old 04-18-2004
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defibrillators

does anyone have a medical opinion about the usefulness of an AED on board for longe range cruisers?
what is a good brand?
thanks
eric
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Old 04-18-2004
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defibrillators

An "AED" could be a real life-saver; but they do cost big ($1,200 - $3,000).
Take a look at:

Regards,
Gord
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Old 04-18-2004
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defibrillators

oops, sorry - the board won''t let me edit.
Lightweight Portable Defribillator:
http://www.heartsine.com/products/index.htm
Gord
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defibrillators

gord are you in the medical profession?
why do you suggest this one over the others?
thanks
eric
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defibrillators

What we commonly think of as a "heart attack" is Myocardial Infarction. This is the death of muscle cells in the heart because of lack of circulation and resultant hypoxia(low oxygen). Angina is the chest pain caused by a temporary lack of circulation without damage to the heart itself, it is relieved by nitroglycerin (or supplemental oxygen) which dilates the coronary artery which branchs from the aorta to provide blood supply to the heart itself.
The atria (upper chambers of the heart, the LUB when you listen to heartbeat) pump blood to ventricles (lower chambers, the DUB) to ''preload''. Ventricular fibrillation is "Disorganized, ineffective quivering of the ventricles" the cells of the heart are contracting individually or in small groups. A defibrillator works by stopping all contractions in hopes that one of the normal pacemakers of the heart will take control when contractions resume. There are several pacemakers in the heart, the normal ones are toward the top and pace at 60-80 per minute. In the middle is the SA (sino-atrial) node which acts as a delay in conducting the nerve impulse from atriums to ventricles allowing the atrium to fill ventricle. If rate drops below 50-60 which is inherent pace of SA node it takes over and paces at that rate. That being said:
40% of AMI (acute myocardial infarction) patients never reach the hospital, about 1/3 of patients never seek medical attention due to denial or absence of pain. A few patients may experience no pain (elderly & diabetics). A variety of lethal and non-lethal arrhythmias (irregular heartbeat) may follow usually within 1 hour. PVCís (premature ventricular contractions) are most common which are the ventricles contracting too soon not allowing complete filling and resultant ineffective contraction which begins cycle again. Follow up care includes intravenous administration of Lidocaine reducing Ďirritabilityí of the ventricles as well as Bicarb to correct acid imbalance of blood due to hypoxia, and other drugs to increase the strength of the contractions.
Cardiogenic shock can occur immediately or as late as 24 hours after onset of AMI, CHF (congestive heart failure) occurs when ventricles can no longer keep up with return flow from atria due to extent of damage, usually within first few hours to first few days of AMI.
So, defibrillation is effective only for AMI leading to V Fib not for a myriad of other cardiac dysfunctions, and immediate follow up care is required. I have used AEDís on 7 patients, all were transported to a hospital within 15 minutes and none survived. Iíve used portable defibrillators on hundreds of patients many of whom survived the initial incident but did not prosper following the event. AEDís do save lives but the odds are really stacked against you even when close to a hospital.
For these reasons I believe best course is to make sure everyone on board (at least us OLD guys) takes 1 baby aspirin per day, ( acts as blood thinner, aids in preventing blockages). If you already have EPIRBís, great lifejackets, Liferaft etc. and got some money left over it couldnít hurt to have an AED but itís way down the list of essential equipment.
Sorry I was so wordy but didnít know how to say that AEDís are good and save lives but the chances of saving a life far from help with one are very low.
Might I suggest the book ďEmergency Care and Transportation of the Sick and InjuredĒ from the American Academy of Orthopedic Surgeons from Jones and Bartlett Publishers.
Iím not a doctor, I was a Paramedic in late 70ís and have supervised paramedics since then, Iím now certified as EMT and have been certified at least at that level since 1971.
Bet this is more than you EVER wanted to know on this subject.
Ted
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defibrillators

Cpttb: Not at all more than I wanted to learn. Thanks for the excellent post!

Kimberlite: Iím not a medico, and have no personal expertise. I suggested the Heartsine on the half-hearted recommendation of an acquaintance, who didnít explain his lack of enthusiasm as well as Ted just did.
Gord
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Old 04-19-2004
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I was a little sleepy last night regarding the pacemakers of the heart, the SA node is at top of heart & is normal pacer at 60-80/minute. AV node (at border of atria & vents.) is in center and acts as delay for transmission between the chambers.
When we experimented with AED''s some time ago I believe the units we used were from Heartsine (first models) and they were well made and pretty sturdy. We are really hard on equipment and didn''t break any. We always say if you put a fireman in a padded room with 2 bowling balls he''ll break 1 and lose the other. T
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ted,
thanks for the note. it was very informative.
from this list and others it seems that the AED is a nice gadget but if we are 6 days from shor it would serve little use.
Thanks
eric

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Old 04-19-2004
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defibrillators

I disagree.
For a known/documented cardiac patient, early defibrilation is the BEST method of ''salvage'' from ventricular fibrilation or pulseless ventricular tachycardia. Yes, there should be immediate drug/therapy followup; but, in an extreme situation such as being far offshore if needed the AED is probably the ONLY (%) means of recovering such a person. For an otherwise ''healthy'' person who experiences VF/VT, sometimes (just sometimes) ALL thats needed is the AED.

If you just want to hang an AED ''on the wall'' in case ''someone'' ... ... ... then your money is probably better spent on "prevention" and a complete cardiac analysis before ever leaving the dock.
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dear rich,
no one on board has a history of heart problems. what is your opinion?
do you suggest a particular AED?
eric
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