In this lesson, you'll learn how to use an AED on a child in cardiac arrest. The methods of defibrillating a child are basically the same as defibrillating an adult. One important distinction involves AED pad size.
AED pads come in an adult size and a pediatric size, for patients less than 55 pounds or roughly 25 kilograms.
Pro Tip #1: If you do not have pediatric pads and the patient is less than 55 pounds, use the adult pads. It's far better to use the wrong size pads than it is to forego using an AED.
Remember, when using an AED, there are a couple of important things to keep in mind as it relates to your surroundings and scene safety.
- 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, drag or 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.
How to Provide Care
Just like the Adult AED lesson, let's assume a few things:
- The scene is safe, and your gloves are on
- 911 has been called
- Someone has brought you an AED
- The victim is already in cardiac arrest
- CPR is already in progress
Remember, when it comes to AEDs, they supply their own instructions after you turn them on. If ever confused, simply follow the prompts as the AED gives them.
AED Technique for Children (55+ pounds)
Pro Tip #2: How do you know what the victim weighs? Easy, you guess. If it's even close, you'll probably be fine using adult pads. However, be aware that pad placement will be different for victims under 55 pounds, which you'll learn in the next lesson – Infant AED.
Warning: Cutting off clothing is better than removing as the victim could have a spinal injury which could be made worse by moving them.
- Turn on the AED.
- Remove the patient's clothing to reveal a bare chest and dry the chest off if it's wet. (Remember, AEDs will typically include a pair of scissors somewhere on the unit.)
- Attach the AED pads to the victim's chest. The pads should have a diagram on placement if you need help. The first pad goes on the top right side of the chest. The second pad goes on the bottom left side of the victim's side, under the left breast. Make sure they adhere well.
- Plug the cable into the AED and be sure no one is touching the victim. The AED should now be charging and analyzing the rhythm of the child's heart.
- If the scene is clear and no one is touching the victim, push the discharge button to deliver a shock. Then go right back into CPR. It's OK to perform CPR over the pads, so don't worry about moving them.
- Perform 30 chest compressions.
- Grab the rescue shield and place it over the victim's mouth and nose.
- Lift the victim's chin and tilt his or her head back slightly.
- Deliver two rescue breaths.
Pro Tip #3: You want to minimize compression interruptions. Don't delay or interrupt compressions any longer than absolutely necessary and this includes after a shock is delivered. Go right back into your compressions.
Continue with CPR until the AED interrupts you. At some point, it will reanalyze the victim's heart rhythm and again advise you on what to do next. If the AED advises a shock, do that. If it advises you to NOT shock the victim, continue with CPR only, again over the pads. (The AED will continue to reanalyze.)
Pro Tip #4: Don't remove the pads and/or turn off the AED, even if it advises you to NOT shock the victim. It's still monitoring the victim and may have different instructions for you at some point.
Continue this cycle of CPR, re-analyzation, charging, shock, back into CPR until EMS arrives, the patient is responsive and breathing normally, or someone who's equally trained or better can relieve you.
A Few 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 victim.
- Do not touch the victim 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 victim or any of the resuscitation equipment.
- Do not use an AED if there are flammable or combustible materials or gases present, including free-flowing oxygen.
- Do not operate an AED inside a moving vehicle, as the movement can affect analysis.
- Do not use an AED if the victim is in contact with free-standing water or in the rain. Move them 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.
