Some situations require special care when using an automated external defibrillator (AED) to treat a victim of cardiac arrest. In the event of a cardiac emergency, you’ll need to understand the special considerations involved when using an AED on:
- Pediatric patients
- Wet or sweaty patients
- Patients lying on snow or ice, or near flammable or combustible materials
- Patients with a hairy chest
- Patients with a medication patch
- Patients with a pacemaker or implantable cardioverter defibrillator
- Patients with jewelry or body piercings
- Patients who are wearing a bra
- Patients who are pregnant
If you are ever in doubt when treating a patient, start performing chest compressions immediately and ask a bystander to consult with emergency medical services over the phone before you deliver an electric shock. If there are obvious signs of cardiac arrest (unconscious and not breathing normally), acting fast will increase the patient’s chance of survival—no matter what other factors are present.
Treating a Pediatric Patient
Cardiac arrest in children is rare[mfn]ncbi.nlm.nih.gov[/mfn] but still a possibility. To cater to pediatric patients, some external defibrillators have a special pediatric setting, and others come with child electrode pads (either included with the AED device or sold separately). In both cases, the pediatric function attenuates the dose to make it suitable for infants and children under eight years of age[mfn]cpr.heart.org[/mfn].
For a child under age eight, adjust the AED as follows:
- Zoll AED Plus. Swap out the adult pads for the ZOLL Pedi Padz II (sold separately) and the voice coaching will change to match.
- Defibtech Lifeline AED. This defibrillator also has pediatric pads that are sold separately. If treating a pediatric patient, simply unplug the adult AED pads and plug in the pediatric pads. The AED will then automatically adjust to pediatric mode.
- Philips HeartStart FRx. Insert the infant/child key (sold separately) to reduce the shock using the same adult electrode pads.
- Physio-Control Lifepak CR2. Press the Child Mode button to deliver a pediatric shock using the same electrode pads that you would use to deliver an adult shock.
- HeartSine Samaritan PAD 350P, 360P, and 450P. Unplug the adult electrode Pad-Pak and plug in the child electrode pads (sold separately). Follow the audio prompts and press the shock button when directed (for the semi-automatic 350P and 450P models).
If no child pads are available, and your device doesn’t have a child setting, you can use standard adult pads[mfn]pubmed.ncbi.nlm.nih.gov[/mfn]. However, the chest placement is different for pediatric patients to prevent the pads from touching. One pad should be placed in the center of the chest immediately left of the sternum[mfn]resuscitationjournal.com[/mfn], and the other in the center of the upper back. Heed this placement for pediatric patients, whether you use adult or child pads.
For an infant under 12 months, a manual defibrillator is preferred over an automated defibrillator[mfn]emedicine.medscape.com[/mfn]—especially if no pediatric pads are available. However, it’s much better to use a portable defibrillator (with pediatric or adult pads) than to do nothing at all.
Treating a Sweaty or Water-Submerged Patient
Special considerations when using an AED also apply when the patient is wet or moist from sweat. When treating a victim of cardiac arrest who is wet or moist, remove them from the water (if they are immersed) and take them to a dry place. Dry off their chest area as much as possible and apply the electrode pads. Please note that AHA guidelines do not mention drying the patient from head to toe—they only mention drying the chest area [1[mfn]ahajournals.org[/mfn]], so don’t waste time drying more of the body than necessary.
The most important factor is that the victim’s chest be dry so that the shock is delivered straight to the heart and is not dispersed to bystanders, as some of the shock could be passed to the operator or a bystander through the water[mfn]researchgate.net[/mfn]. If the victim is in a puddle or lying on a wet area of the floor but their chest is dry, simply move them away from the water and use the defibrillator as normal.
Treating a Patient on Other Surfaces
A few additional considerations are related to the question of whether AEDs can be used around water:
- It is safe to use an AED if the patient is lying on snow or ice [2[mfn]ahajournals.org[/mfn]].
- Check for any metal surfaces that connect the patient and the person operating the AED [3[mfn]ahajournals.org[/mfn]].
- You should never use an AED in a volatile atmosphere, as flammable substances like petrol or aviation fumes could ignite with a spark [3].
Treating a Patient With a Hairy Chest
When a cardiac arrest victim has excessive chest hair, it may be difficult for the electrode pads to analyze their heart rhythm and deliver an appropriately timed shock. This is because the hair would lift the pad up and off the patient’s chest, preventing full contact with the skin. The hair would also make it more difficult for the conductive gel on the electrode pad to adhere to the skin.
There are three main solutions to the issue of chest hair, as recommended by the American Heart Association [1]:
- Shave the hair off the area where the patch will be applied. It is sensible to keep a disposable razor stored with every AED specifically for this purpose. Most first-aid kits and first-responder kits should include at least one razor.
- If you don’t have a razor and the device continues to prompt you with “check pads,” push down hard on the electrode pads to increase conductivity. Remove your hands when instructed to “stand clear.”
- If the machine still doesn’t respond, you can strip the pad quickly off the patient’s chest in an attempt to remove some of the hair. Then apply a new set of pads. Only do this if you have extra pads on hand.
Treating a Patient With a Transdermal Medication Patch
Transdermal medication patches deliver active medication, such as a hormone or nicotine, at a gradual rate through the skin. In the case of a cardiac arrest, medication patches can deflect energy away from the heart if the shock is delivered over the patch [3].
Before applying an AED, remove the medication patch and wipe any sticky residue off the patient’s skin. It’s a good idea to wear gloves when removing the patch so that the medication is not absorbed through your skin.
Treating a Patient With a Pacemaker or Implantable Defibrillator
Pacemakers and implantable cardioverter defibrillators represent another category of special considerations when using an AED. If you place an AED directly over a pacemaker or defibrillator, the device may block some of the current from the shock or become damaged [2]. To prevent this, place the electrode pad a few inches lower or try an anterior-posterior (front-and-back) AED pad placement instead.
You can usually tell if a cardiac arrest victim has an implanted pacemaker or defibrillator because they will have a scar on either side of their upper chest or abdomen with a hard lump the size of a deck of playing cards or smaller. Most often this will be near the heart, on the left side of the chest, in which case it will not interfere with the standard pad placements.
Please note: If the patient has an implantable cardioverter defibrillator and has suffered a sudden cardiac arrest, it’s almost certain that the device has stopped working. In any case, you shouldn’t worry about damaging the device because machines can be replaced—lives can’t.
Treating a Patient Who Is Wearing Jewelry or Has Body Piercings
If a victim of cardiac arrest is wearing metal jewelry or metal body piercings on their chest and they aren’t easily removed, don’t waste time taking them off before using an AED. While there may be a small risk of burns, this risk is outweighed by the need to avoid delays in defibrillation [3]. However, to optimize the contact between the pads and the bare skin, it is recommended to adjust the AED pad placement by a few inches to prevent direct contact between the electrode pads and any of the metal jewelry or body piercings.
Treating a Patient Who Is Wearing a Bra
For optimal AED functionality, electrode pads must be applied directly to bare skin. If a patient is wearing any type of bra, whether that be a sportswear bra, bikini top, or underwire bra, it should be cut just as with any other kind of clothing to allow direct access to the skin in the frontal chest area [3]. For modesty, you can ask bystanders to stand around the patient (facing outwards), as a shield.
Treating a Patient Who Is Pregnant
The American Heart Association (AHA) endorses the use of an AED in the event of cardiac arrest in a pregnant patient[mfn]ahajournals.org[/mfn]. When applying the pads, follow the same placement procedure as with non-pregnant patients. Remember, the AED will only deliver an electric shock if it identifies a shockable heart rhythm. It is crucial to promptly restart the mother’s heart for the baby’s survival.
Prepare Ahead and Take Immediate Action
Sometimes, you’ll come up against special issues when using an AED and you need to be prepared. You can generally use an automated external defibrillator on these patients as you would on any other with a few simple adjustments.
To be ready for whatever you might encounter, make sure your AED is equipped with pediatric pads (or a pediatric key, depending on the model), a razor, a pair of scissors, and a pair of gloves. Then, proceed without fear. That shock could save their life!
Information Sources
