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Now, let's cover the use of an automated external defibrillator, otherwise known as an AED, with an infant while a CPR is already in progress. Now, I either require the AED myself, or someone's brought it on scene, and it's now available, but there is a couple points of scene safety that need to be made prior to turning that on, and that is, is the baby laying in a puddle of water? this would maybe be most seen like if the baby was pulled out of the pool or pond or lake, and the water has now dripped into a bit of a pool of water, and we're kneeling into that water. With the conduction of electricity, it may or may not happen, but we don't wanna take any more chances. So, we simply would move the baby to a drier ground, pat off the baby's chest and back, so that the pads adhere to the skin, and that would be just fine. While we're talking about wetness and dampness, there's been some questions about a wet diaper and using an AED. A wet diaper is no problem. Remember, we're concerned about a puddle or a pool of water that the baby is laying in, not just damp clothing or dampness around the baby. While we're looking at the surface of the baby, let's talk about jewelry for some moment. There has been some concerns that the baby might have been wearing a necklace or something, and it might cause some problems when using the AED. That's not the case, just simply move the necklace to the side, out of the way of the AED pad, and you should be just fine. Now, thirdly though is the combustible issue. Are there any combustible gases or flammable liquids or anything in the environment that if we had a spark, there would be problems. If the scene is safe, then you're ready to use the AED, so let's continue. The first thing we wanna do with the AED when we have it, is turn it on. Once we turn the AED on, we will follow the promptings. It's prompted us to remove the clothing, so that we can actually access the points that are important for placing the pads on the baby. As we turn the AED over, it has two sets of pads. The pediatric sized pads, and the adult sized pads. In this case, obviously we wanna use the pediatric sized pads. When you open up the pads, you'll see in most cases, a diagram that shows you where to place the pads. So, this very first one, we'll take off and we'll place it as the diagram shows right on the center of the chest. Make sure that it's stuck well and not peeling up as that can affect the way the actual pad works. Now, we take the second pad off, carefully rolling the baby up on to its side, protecting its head and neck, we place it into its appropriate location between the shoulder blades on the center of the back of the baby, and then roll them back on to their back. Now, the AED is prompting insert electrodes or connect the wires. So, we do that, we plug it in, and we follow the prompts. It's at this point, that we wait for the AED to actually charge, and then encourage us to push the flashing button to rescue. Making sure we're not touching the patient, it's prompting us to push the flashing button, and so we do. As soon as we deliver the shock, it's vital to remember that per current research and guidelines, we don't wanna delay the very first compression following the shock. We want to minimize that time gap, so that we're getting the pulse pressures back up as soon as we can, and getting good circulation of oxygenated blood as fast as we can. So now we can begin with our 30 compressions followed by two rescue breaths. We're following the same guidelines that we follow with the CPR, which is compressing a third of the depth of the chest or approximately one to one and a half inches deep, and we're going to compress at a rate of at least a 100 to 120 compressions per minute, no more than 120 compressions per minute which is about two a second. One, and two, and three, and four, and five, and six, and eight, nine, and ten, and eleven, and twelve, and thirteen, and fourteen, and fifteen, all the way up to thirty compressions. We take our mask, we put our one-way valve shield over the baby's mouth and nose and deliver two rescue breaths. We deliver our two rescue breaths, and then we go back to our chest compressions for 30 more times. Now note here that I am pressing here over the pad. At no point, would I want to remove the pads from the back or the chest of the baby. We're gonna leave everything intact, and do our CPR right over it. You will be interrupted potentially from time to time by the AED, simply follow the prompts, and continue your protocol until EMS arrives, something equally trained higher comes to relieve you or the baby actually regains consciousness. But if the baby actually regains consciousness and starts to breathe on their own, though we may stop doing CPR at that time, we would leave the AED intact, and allow it to monitor the patient until EMS arrives and takes over.
In this lesson, you'll learn how to use an AED on an infant who's gone into cardiac arrest. The methods of defibrillating an infant differ a little from adults and children, so be sure and make note of those differences.
As you know, AED pads come in two sizes – adult and pediatric. Pediatric pads are for patients less than 55 pounds or roughly 25 kilograms, while adult pads are for anyone weighing more than 55 pounds.
Remember, 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.
Infant-related cardiac arrests are typically the result of:
- Drowning
- Choking/airway obstruction
- Electrocution
This is important for reasons of scene safety. If the infant was pulled from a pool, is he or she laying in too much water to safely use an AED?
If the infant was electrocuted, is the source of that electricity still a threat? It's always important to make sure the scene is safe before helping another person, but it's especially important when using an AED, where one spark can cause a lot of problems in the wrong situation. (And why we often mention combustible gases and flammable liquids in our scene safety warnings.)
How to Provide Care
Just like the last two AED lessons, we're going to assume a few things:
- The scene is safe, and your gloves are on
- You or someone else has called 911
- You have an AED that's ready to use
- The infant is already in cardiac arrest
- CPR is already in progress
AED Technique for Infants (less than 55 pounds)
- Turn on the AED.
- Remove the infant's clothing to reveal a bare chest and dry the chest off if it's wet. Since one pad will go on the infant's back, be sure that area is also accessible and dry.
- Attach one AED pad to the infant's chest, roll the baby over onto his or her side carefully while supporting the head and neck, and attach the second pad to the center of the infant's back between the shoulder blades.
Pro Tip #1: The AED should include a diagram on pad placement if you ever need help. And make sure they adhere well and aren't peeling off, as this will affect the AED's effectiveness.
- 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 infant'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.
Remember, 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.
- Perform 30 chest compressions.
- Grab the rescue shield and place it over the victim's mouth and nose.
- Seal your mouth over the infant's mouth and nose.
- Deliver two rescue breaths – Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath.
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.)
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 Common Questions About AED Use
Why is it so important to not disrupt or delay CPR compressions?
Current research suggests that minimizing all delays is important for victim recovery, including that first compression after an AED shock. Compressions immediately help get the victim's pulse pressures back up and oxygenated blood circulating again.
Will a wet diaper cause a problem with an AED?
No. As wetness concerns AED use, as long as the victim isn't submerged in a pool or puddle of water, you should be fine. Keep in mind that the only areas that need to be dry are those where the pads will go.
Can I remove the pads if the victim begins breathing normally again?
No. Keep the pads on until EMS or other advanced medical personnel take over. The AED will continue monitoring the victim and will advise you again should problems arise, so keep the pads on and the AED turned on.