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When Not to Use a Defibrillator

When Not to Use a Defibrillator

When Not to Use a Defibrillator

When a person is experiencing sudden cardiac arrest (SCA), they only have a short window of time to be resuscitated. In cardiac arrest, the person’s heart stops beating rhythmically and instead flutters or quivers chaotically. If nothing is done, heart activity ceases completely. If the person dies, this is referred to as sudden cardiac death.

Automated external defibrillators can often restore a normal rhythm during those critical first moments, saving the victim’s life. There are some cases in which you should not use an AED. However, those cases are extremely rare. Knowing when and when not to use a portable defibrillator can help you be better prepared.

Situations in Which You Shouldn’t Use an AED

There are certain rare instances when using a defibrillator may be unwarranted or ineffective. You should avoid administering an electric shock if:

The Person Is Suffering From a Heart Attack

It’s common to confuse heart attack and cardiac arrest. However, these are completely different conditions with different protocols. A heart attack is a plumbing issue while cardiac arrest is an electrical issue. An electrical shock from an AED will not help in the case of a heart attack because the cause of a heart attack is not electrical.

The good news is that it’s easy to tell the difference between a heart attack and cardiac arrest. If the person is in pain but is still breathing and responsive, it’s most likely a heart attack or another problem that does not require an AED (note: you should still call 9-1-1 or take the person to the emergency room). If the person is unresponsive and not breathing or is only breathing in gasps, you’re probably dealing with cardiac arrest and should defibrillate as soon as possible.

The AED Is Faulty or Has Expired Parts

AEDs perform daily, weekly, and monthly self-tests to ensure readiness. When you turn on the device, it should confirm—via a green light or other on-screen indicator—that the device is ready to use. Also check the expiration date on the battery and electrode pads. The device won’t be able to do its job and may endanger the victim if it has a low or expiring battery. In this case:

  • Call 9-1-1.
  • Perform hands-only CPR.
  • Send someone to look for another defibrillator.
  • Continue to perform hands-only CPR while you wait for the emergency services to arrive.

The Victim Has a DNR

This is more of an ethical issue than a safety issue, but it is still important to address. If you see a “Do Not Resuscitate” tattoo or DNR bracelet on the victim, defibrillation may violate their wishes.

You probably won’t be subject to legal recourse for treating the individual. Good Samaritan laws will protect you in most cases. Nevertheless, if you do see evidence of a do-not-resuscitate order before taking action, you’ll need to make the difficult decision of whether to honor the victim’s expressed wishes or save their life regardless.

When to Use a Defibrillator

An automated external defibrillator should always be used when someone goes into cardiac arrest unless the device is inoperable or the victim has clear evidence of a DNR order and you decide to respect their wishes.

The first sign of cardiac arrest is usually fainting. If the victim appears unresponsive, try shaking, pinching, and shouting at them. If they appear unconscious or in a seizure-like state, and they don’t appear to be breathing or are only breathing in gasps, you’re most likely dealing with SCA. In this case:

  1. Start chest compressions while someone else calls 911. Cardiopulmonary resuscitation with rescue breaths should only be attempted by a trained rescuer.
  2. Send someone to fetch the nearest AED.
  3. Attach the AED pads to the person’s chest according to AED pad placement guidelines and follow the voice instructions.

Remember that every second matters. A cardiac arrest victim’s chance of survival reduces by around 5.5% for every minute without CPR, defibrillation, and definitive care, so it’s essential to act immediately.

Additional Warnings

In some cases, special considerations when using an AED may apply. While these considerations should not deter you from using a defibrillator, they may influence how you administer treatment.

The Victim Is Wet or Lying in Water

Water and electricity don’t mix. If a cardiac arrest victim is wet or lying in water, move them away from the liquid and dry their chest completely before attempting to administer a shock. In addition, if there are any combustible materials nearby, such as solvents or fuel, move away from the source of the materials before using the device.

The Victim Has a Medication Patch or Pacemaker

A pacemaker is easy to spot. It’s about half the size of a deck of cards and will look like a hard lump in the victim’s chest. Do not place an AED pad directly on top of a pacemaker as the pacemaker could block some of the shock [1]. Instead, place it as close to the target area as possible without touching the pacemaker.

If the patient is wearing a medication patch on their chest, quickly remove it and rapidly wipe the area before applying the pad. Do not attempt to place the pad directly over the patch, as the patch could compromise the effectiveness of the shock and may cause small burns [1].

The Victim Has a Hairy Chest

Excess body hair can interfere with the AED’s ability to detect a shockable rhythm. The AHA provides the following guidelines:

  1. If a razor is available, shave the target area before applying the pads.
  2. If no razor is available but you have a second pair of electrode pads, press down hard on the pads and rip them off quickly to remove as much hair as possible. Then, apply the second set of pads.
  3. Apply as much direct pressure to the pads as possible to ensure conduction. (Just make sure not to touch the victim’s bare skin while administering a shock.)

Infants, Children, and Pregnant Women

Portable defibrillators can be used on infants (under one year of age), children, and pregnant women. Take the following into account:

External Defibrillator Side Effects

In most cases, an automated external defibrillator works without causing harmful side effects. However, if the device is improperly administered, it may fail to deliver the necessary shock. This may keep the victim in cardiac arrest.

If the person is sensitive to the adhesive gel on the defibrillator pads, they may experience contact dermatitis. However, the instance covered in the linked case study was related to a wearable cardioverter defibrillator, was treated effectively with topical medication, and cleared up within a couple of weeks of pad removal (so it’s not a great cause for concern). By heeding the guidelines above, you can also minimize the likelihood of other side effects, such as burns.

What If There Is No Shock Advised?

There could be some situations in which a defibrillator analyzes the victim’s heart rhythm and returns a message of “no shock advised.” In this case, you should continue with chest compressions and leave the electrode pads attached in case the patient’s heart rhythm changes to an AED shockable rhythm, such as ventricular fibrillation or ventricular tachycardia.

You Have Just Minutes to Decide

It’s generally easy to determine when to use and when not to use a defibrillator. To recap it as simply as possible, it all rests on three basic questions:

  1. Is it cardiac arrest?
  2. Is the AED operable?
  3. Is it safe to deliver electric shocks to the victim?

If you can answer yes to all three questions, it’s time to grab the defibrillator. If the answer to any of the above questions is no, consider other options.

You never know when a cardiac emergency will strike, so make sure to keep a working AED device—such as the ZOLL AED Plus or Defibtech Lifeline—on hand at all times. Someday, it may save a life.

Disclaimer for information purposes only:

Our website provides information for general knowledge and informational purposes only. We do not offer medical advice, diagnosis, or treatment. Readers should consult with qualified healthcare professionals for personalized medical advice.

While we endeavor to ensure the accuracy and reliability of the information provided, we do not guarantee its completeness or suitability for any specific purpose. The use of this website is at the reader’s own risk.

By accessing and using this website, you agree to indemnify and hold harmless the website owners, authors, contributors, and affiliates from any claims, damages, liabilities, losses, or expenses resulting from your use of the information presented herein.

Picture of Michelle Clark, RN ICU/CCU
Michelle Clark, RN ICU/CCU
As a seasoned Nurse (RN) in Critical Care, CCU (Cardiac Care Unit), and ICU (Intensive Care Unit) with nearly three decades of experience, specializing in Cardiopulmonary care, I've embarked on a new path as a trusted figure in the realm of sudden cardiac arrest and first aid. With a profound dedication to patient well-being honed throughout my nursing career, I now utilize my expertise to enlighten and empower others in life-saving methods. Leveraging my comprehensive understanding and proficiency in critical care, I endeavor to leave a lasting imprint in healthcare by promoting awareness and offering practical guidance.
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