AED On Hockey Player

robbaN28

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Here's the Scenario:

Hockey player collapses on the ice.
He's 55, no history of any cardiac problems. Teammate begins CPR while another teammate gets the AED.
When they are about to attach the AED, they notice that the hockey player is laying in a small pool of water.
Remember, this rink has excessive amounts of water on the ice because they just zamboned the ice.
What do you do? Take him off the ice or shock him there? This was a real scenario that came up in discussion in class.
 
yes. take him off the ice. imagine how hard it is gonna be to do CPR while slipping on the ice
 
Agreed. Move him off the ice, definitely move him if there isn't suspected spinal injury, the ice is enough of a safety hazard without adding electricity to the mix.
 
See posts about second hand defib and pool rescues.

I never thought about ice as a conductor. Hm.
Delay versus inconvenience.
 
I never thought about ice as a conductor. Hm.
Delay versus inconvenience.

I think the key point here is that it was recently wetted ice by the zamboni
 
True, but wouldn't the water put on by the Zamboni freeze fairly quickly since it's a thin layer?
 
Based on the limited information, if there's reason to suspect C-spine issue I'd get someone on head stabilization and get him moved off the ice as quickly as possible, then AED him. If no reasonable expectation of c-spine compromise, I'd haul him off the ice and then hook him up. I'd rather not be the poor SOB who finds out the hard way that we should've moved him.

The extra few seconds is DEFINITELY worth the assurance that you have ONLY one patient, not 3 or 4.
 
Nah.. i say leave em and zap em... besides.. you'll already have a head start on your induced hypothermia!
 
True, but wouldn't the water put on by the Zamboni freeze fairly quickly since it's a thin layer?

Depends on the rink. This rink had a pretty unusual high temperature in it. So the water freezes slowly. Takes about 5-15 minutes for it to freeze completely.

Based on the limited information, if there's reason to suspect C-spine issue I'd get someone on head stabilization and get him moved off the ice as quickly as possible, then AED him. If no reasonable expectation of c-spine compromise, I'd haul him off the ice and then hook him up. I'd rather not be the poor SOB who finds out the hard way that we should've moved him.

The extra few seconds is DEFINITELY worth the assurance that you have ONLY one patient, not 3 or 4.

C-spine was not an issue. The player just fell for "no reason" and collapsed on the ice. Remained unresponsive.
 
I would follow the accepted guidelines from AHA. While it is true that water conducts electricity, remember that we use two pads because the electricity will travel between the two pads. It is not as if we are throwing a live wire at them and it might hit the puddle of standing water. So, you expose the chest, quickly wipe the chest of moisture, and shock ASAP! Since CPR is one of those basic skills that you all should have down pat I would recommend rereading the 2005 guidelines from AHA, which includes:

Water is a good conductor of electricity. Do not use an AED in the water. If the victim is in water, pull the victim out of the water. If the victim’s chest is covered with water, water may conduct the electricity across the skin of the victim’s chest. This prevents the delivery of an adequate shock dose to the heart.

If water covers the victim’s chest, quickly wipe the chest before attaching the electrodes. You do not have to completely dry the chest — just quickly wipe. If the victim is lying on snow or in a small puddle, you may use the AED.


As far as that back boarding idea goes… Beyond the fact that back boarding is an overused and often unnecessary skill, unless there is a specific glaring indication for the boarding, I will not waste time (remember that death outweighs all other medical conditions in severity). However, if time and manpower exists (and it does not take time away from resuscitation efforts) I might slip a board underneath in order to have a more stable platform and for ease of movement.

But, I will not waste time with moving the patient from the ice or in back boarding. TIME IS HEART!!! Shock Him.
 
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There is some scientific studies that have been conducted with some positive results with the use of AED in standing water.

That's kinda of shocking. Ohm... I guess water doesn't decrease resistance that much to be a safety hazard.
 
I think we need to specify the difference between cervical spine precautions and backboarding when it comes to arrests. Placing the patient on a long spine board allows easier movement both at the facility and from the ground to the gurney if transport is required. Additionally, it will provide a more stable surface for compressions since there the compression is transmitted through more of the mattress (less force lost to compressing the mattress). Additionally, cervical spine precautions can help prevent ET tube dislodgement. Thus, depending on the totality of the circumstances, a back board can be used as a movement adjunct, even without the full c-spine precaution gear (i.e. C/C and head beds). Additionally, since it is being used as an adjunct to facilitate movement, if it needs to be discontinued, there shouldn't be the problem of removing a patient from c-spine precaution because the patient was never in c-spine precaution.
 
Consider collapse (fall) from standing height and the amount of protective gear a hockey players wears, I would the odds of spinal compromise is slim. Emergency drag off the ice.
 
Depends on the rink. This rink had a pretty unusual high temperature in it. So the water freezes slowly. Takes about 5-15 minutes for it to freeze completely.

Then what the heck were they doing on the ice? Going out before it's frozen ruins it....they may as well have not zamed it.

zap him there, early defib. It is going to take a few mins to get him off the ice. You can't really just pick him up and drag him, it will be too slick for the rescuers.
 
Then what the heck were they doing on the ice? Going out before it's frozen ruins it....they may as well have not zamed it.

zap him there, early defib. It is going to take a few mins to get him off the ice. You can't really just pick him up and drag him, it will be too slick for the rescuers.

Okay, okay, haha. I realized that I didn't explained this fully through.
There are ice rinks with different temperature heating above the ice. This rink it's extremely hot for being a rink. It's still playable to be on the ice after the Zamboni has been on the ice. Also, they tend to dump a lot of water on the rink while Zamming, since they did have an incident when the ice was too thin a couple years ago.
 
id just wipe the chest and shock.. unless the water is like more then an inch high around me

also if you remember abc or even acbc airway still comes before c spine
 
Where are our canadians at...how come they arent chiming in?

ok since im canadian ill chime in i have used an aed on a pool deck and on an ice rink no ill effects the only thing we were told is make sure you are not in a large pool of water when using it . i agree with trying to do cpr on ice it is not comfortable but with the equiptment we had(no equiptment) leaving the patient on the ice was the right thing to do at the time.
 
I play hockey all the time. I ve been to ice arenas where the conditions are terrible. Trust me..standing water on the ice can/does exist. Clear C-spine and get your patient off the ice. Additionally, this makes getting the patient to the ambulance when the responding crew shows up a lot easier.
 
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