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.
Warning: 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, 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.
Pro Tip #2: It's OK if the victim or the victim's clothing is wet, as long as the chest area 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?
If you don't get an initial response, place your hand on the victim'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 or call in a code if you're in a healthcare setting. 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.
- Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc.
- Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse.
- If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with your AED.
AED Technique for Children
- Turn on the AED.
- Remove the patient's clothing to reveal a bare chest.
- Attach the AED pads to the patient's chest. The pads should have a diagram on placement if you need a reminder. The first pad goes on the top right side of the chest. The second pad goes on the bottom left side mid axillary, under the left breast.
- Plug the cable into the AED and be sure no one is touching the patient, including yourself. The AED should now be charging and analyzing the rhythm of the patient's heart.
- If the scene is clear and no one is touching the patient, push the flashing shock button. Then go right into CPR. It's OK to perform CPR over the pads, so don't worry about moving them.
- Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them.
- Consider the size of the child when doing compressions, use one hand for a smaller child and two hands to perform compressions on older children. It also depends on the size and strength of the rescuer if one or two hands are needed to supply the proper chest compressions.
- Conduct compressions that go 1/3 the depth of the child's chest, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
- Perform 30 chest compressions.
- Grab the rescue mask and seal it over the victim's face and nose.
- Lift the victim's chin and tilt his or her head back slightly.
- Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath.
- After one round of CPR, let the AED analyze the patient again. If the AED advises you to perform another shock, make sure no one is touching the patient and press the shock button.
- Go right back into CPR.
Continue this cycle of CPR, re-analyzation, charging, shock, back into CPR until help arrives, the patient is responsive and breathing normally, or the next level of care takes over.
A Word About Special AED Situations
Some special considerations should be given when using an AED in certain situations. These include using an AED on a patient who's wearing an implantable device, a patient who's suffering from hypothermia, and a patient with an excessive amount of chest hair.
Implantable Devices
Implantable devices, like pacemakers, are sometimes located below one of the collarbones in the area where one of the AED pads should go. This can be problematic as the device could interfere with shock delivery.
An ICD (Implantable Cardioverter-Defibrillator) is another common implantable device you may encounter. It's sort of like a mini version of an AED, as it detects abnormal heart rhythms and restores them to normal.
If one of these devices is visible – a small lump can sometimes be seen or felt – or if you know the patient has one in a specific location, do not place the AED pad on top of it. Instead, adjust the placement of the pad to avoid the device.
Hypothermia
As already mentioned, patients who are wet pose no problems when using an AED, provided they are not submerged in water, water is not connecting the patient with the responder or anyone else, and the wet clothing is removed from the upper torso and the chest is dried off.
Patients who are suffering from hypothermia do not require rewarming before using the device. However, you will want to handle them gently, as shaking them could result in V-fib.
Excessive Chest Hair
Chest hair rarely interferes with AED pad adhesion, but it is nonetheless a possibility. If the patient has excessive chest hair, press firmly on the pads when placing them on the victim's chest. If you get an error message, like check pads, or something similar, remove them and replace them with new pads.
Some of the patient's chest hair will likely come off with the old pads, which may solve the problem. However, if the AED still refuses to work, you'll have to shave the patient's chest before applying the third round of pads. This is why it's important to have a safety razor in your AED kit.
