AED pads come in an adult size and a pediatric size, for patients less than 8 years old or 55 pounds - roughly 25 kilograms.
However, remember, if you do not have pediatric pads and the patient is less than 8 years old or less than 55 pounds, use the adult pads. It's far better to use the wrong size pads than it is to forgo using an AED. If placing the pads on the chest, pads cannot touch. If using adult size pads on a child, you may place them one on the center of the chest and the other on the center of the back to avoid touching, like you would for an infant.
Also, remember that when using an AED, there are a couple of important things to keep in mind as it relates to your surroundings.
- Are there combustible gases or liquids at the scene?
- Are there any liquids that could connect the victim with yourself, the responder, or someone else, that could result in electrocution?
If for some reason the scene isn't safe enough to use an AED, move the patient to a safer area where you won't have to worry about explosives or electrocution from water and then use the AED.
And one last reminder: It's OK if the victim or the victim's clothing is wet, as long as the area where pads will be placed is dry and you or the victim aren't submerged in water or connected by it.
How to Provide Care
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive.
Are you OK? Can you hear me? (With children, shouting their name may help.)
If you don't get an initial response, place your hand on the child's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps.
- Call 911 and activate EMS.. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions.
- If you've determined at this point that the victim is unresponsive, not breathing normally, continue immediately with your AED.
AED Technique for Children
- Turn on the AED.
- Remove the patient's clothing to reveal a bare chest.
- There are two pad placement options for children based on their size. The pads should have a diagram on placement if you need a reminder. Determining the size for pad location can be as simple as if the pads look like they will touch each other on the chest, then use the front and back locations.
- For small children, attach one AED pad to the center of the child’s chest, roll the child onto his or her side, and attach the second pad to the center of the back, between the shoulder blades.
- For larger children placement is the same as an adult. One on the upper right chest, just below the collar bone. The other pad is placed on the lower left side of the chest, mid axillary line, below the breast.
- Plug the cable into the AED and be sure no one is touching the patient, including yourself. Some AEDs will have the cable already plugged into the device. The AED should now be analyzing the heart rhythm.
- The AED will find one of two options, either a shockable rhythm or a non-shockable rhythm.
- For a shockable rhythm, the AED will charge itself to deliver the shock.
- If the scene is clear and no one is touching the patient, push the flashing shock button. Some AEDs will shock automatically, so be sure to listen to the directions of the AED.
- For a non-shockable rhythm or after the AED does shock, we immediately go right back into CPR starting with compressions. It's OK to perform CPR over the pads, so don't worry about moving them.
- Perform 30 compressions that go about 2 inches deep, or 1/3 the depth of the chest, and at a rate of between 100 and 120 compressions per minute, which amounts to almost two compressions per second.
- Grab the appropriately-sized rescue mask or face shield and seal it over the victim's face and nose and tilt back the head to open the airway.
- Breathe into the rescue mask or face shield and wait for the chest to rise and fall before administering the second breath.
- Continue with 30 compressions to 2 breaths.
- Every 2 minutes of CPR, the AED will analyze the heart again. Follow the directions and go right back into CPR.
Continue this cycle until help arrives, the patient is responsive and breathing normally, the scene becomes unsafe for you, or the next level of care takes over.
A Word About AED Precautions
When using an AED, there are several precautions to keep in mind. Some of these may be obvious (and a repeat of what you've already learned in this course), while others may not be.
- Since alcohol is flammable, do not use anything with alcohol on it to wipe the patient's chest or back dry.
- While it's OK to use adult pads on a child, the reverse isn't entirely true, as pediatric pads may not deliver enough energy to defibrillate the adult patient.
- Do not touch the patient while the AED is conducting an analysis, as this may affect the analyzation process.
- Before delivering an AED shock, make sure no one is touching the patient or any of the resuscitation equipment.
- Do not use an AED if there are flammable or combustible materials or gases present.
- Do not operate an AED inside a moving vehicle, as the movement can affect the analysis and shock incorrectly.
- Do not use an AED if the victim is in contact with free-standing water or in the rain. Move the patient first.
- Do not place AED pads on top of any patches or implantable devices. Remove patches first and adjust the pads as necessary to avoid devices like a pacemaker.
