There are situations that 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 with a hairy chest
- Patients with a medication patch
- Patients with a pacemaker or implantable defibrillator
If you’re 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 a cardiac arrest, 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 but still a possibility. Child patients require a reduced electrical shock if they are under eight years old or weigh less than 55 pounds. To cater to pediatric patients, some external defibrillators have a special pediatric setting, and others come with child electrode pads (either included with the device or sold separately).
For a child under age eight, adjust the AEDs as follows:
- HeartSine Samaritan PAD 350P. 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.
- Defibtech Lifeline AED. This defibrillator also has pediatric pads that are sold separately. If treating a pediatric patient, simply unplug the adult pads and plug in the pediatric pads. The AED will then automatically adjust to pediatric mode.
- 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.
- Philips HeartStart FRx. Insert the infant/child key (sold separately) to reduce the shock using the same adult electrode pads.
- Zoll AED Plus. Swap out the adult pads for the ZOLL Pedi Padz II (sold separately) and the voice coaching will change to match.
If no child pads are available, and your device doesn’t have a child setting, you can use standard adult pads. However, the chest placement is different for pediatric patients. One pad should be placed in the center of the chest, and the other in the center of the back. Heed this placement for pediatric patients, whether you use adult or child pads.
For an infant under 12 months, a manual defibrillator is more appropriate than an automated defibrillator—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 with a patient also apply when the patient is wet or moist from sweat. Because water is an excellent conductor of electricity, the power of the shock would be dispersed across the patient’s body and be less effective where it’s needed the most.
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. There is no need, nor do you want to use the time, to completely dry the patient from head to toe, focus only on completely drying the chest area, specifically the area between the pads.
The most important factor is that the victim’s chest be dry so that the shock is delivered straight to the heart. 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 With a Hairy Chest
When a cardiac arrest victim has excessive chest hair, it may be difficult for the electrode pad 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 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’s Basic Life Support Provider Manual:
- 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 kids 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. Then 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 have been used since the 1970s to 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 present a burn hazard when using an external automated defibrillator if the shock is delivered over the patch.
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 defibrillators make up the last category of special considerations when using an AED. If you place an AED directly over a pacemaker or defibrillator, the device may block the delivery of the shock. Instead, place the electrode pad a few inches lower or try an anterior-posterior (front-and-back) 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. If they have 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.
Sometimes, you’ll come up against special issues when using an AED and you need to be prepared. The most common special considerations when using an AED involve pediatric patients, patients who are wet or moist, patients with excessive hair, patients with a medication patch, or patients who have a device that could get in the way when you’re trying to deliver a shock.
With a few simple adjustments, you can use an automated external defibrillator on these patients as you would on any other. Make sure your AED is equipped with pediatric pads, a razor, and a pair of gloves and you should be ready for anything.