Pediatric cardiac arrest demands immediate and precise action from bystanders and first responders. When a child collapses, the rapid deployment of an Automated External Defibrillator (AED) is a time-sensitive intervention that can save a life. A challenge arises when an available AED unit is equipped only with standard adult electrode pads, lacking the specialized pediatric versions. This guidance provides clear, actionable instructions for managing this high-stress emergency, ensuring the child receives the best possible chance of survival.
Understanding the Difference in AED Pads
The distinction between adult and pediatric defibrillator pads is rooted in both electrode size and the energy delivered. Adult pads are designed for individuals typically eight years and older, or those weighing more than 55 pounds (25 kilograms). These pads deliver a high-energy electrical shock, commonly ranging from 150 to 200 Joules, which is appropriate for a mature heart.
Pediatric pads are intended for smaller patients, generally infants and children under eight years of age. They are physically smaller and incorporate a specialized circuit known as an attenuator. This attenuator reduces the energy output from the AED to a lower, safer dose for a child, typically around 50 Joules.
This energy reduction is a safeguard against potential myocardial damage or burns from an adult-level shock. The smaller size of the pads also ensures the electrical current passes effectively through the heart and does not short-circuit.
Actionable Steps When Only Adult Pads Are Present
If a child experiencing sudden cardiac arrest needs defibrillation and only adult pads are immediately available, proceed with the adult pads without hesitation. Delaying treatment to search for pediatric equipment significantly decreases the chance of survival. The certainty of death from an uncorrected lethal heart rhythm outweighs the potential risks associated with an elevated energy dose.
The procedure begins by ensuring that high-quality cardiopulmonary resuscitation (CPR) is continuously underway until the AED is ready for use. Once the AED is retrieved, the responder must power it on and follow the voice prompts. The next step involves exposing the child’s chest and quickly applying the adult pads to the bare skin, ensuring the surface is as dry as possible.
Using adult pads introduces the risk of over-shocking, which could cause tissue damage or skin burns due to the higher energy level. However, current emergency guidelines emphasize that delivering a shock, even a higher-energy one, is preferable to delivering no shock at all. Prioritize the immediate delivery of defibrillation once the pads are correctly applied.
After the pads are securely placed, the AED will analyze the heart rhythm and advise whether a shock is necessary. Responders must ensure that no one is touching the child before pressing the shock button or allowing the automated shock to be delivered. The immediate goal is to interrupt the chaotic electrical activity of the heart and allow a normal rhythm to resume, regardless of the pad type used.
Safe Placement Techniques for Adult Pads on Children
When using oversized adult pads on a small child or infant, the placement technique must be modified. This addresses two main concerns: preventing the pads from touching and ensuring the electrical current effectively crosses the heart. The standard adult placement, known as anterolateral, is generally impossible on a small torso because the pads would overlap or come too close. Overlapping pads can cause the electrical current to short-circuit, rendering the shock ineffective and potentially causing arcing burns.
For small children and infants, the recommended approach is the Anterior-Posterior (front-back) placement. This technique maximizes the distance between the electrodes and places the heart directly in the path of the electrical current.
One adult pad should be placed on the child’s chest, typically over the upper right chest near the breastbone. The second adult pad is then placed on the child’s back, positioned between the shoulder blades. This front-to-back configuration ensures the heart is effectively captured within the electrical field, despite the pads’ large size. This technique prevents the pads from touching, which is paramount for safety and efficacy.
Adult pads must never be cut or folded to make them fit on the child’s body. Modifying the pads can damage the conductive gel or electrode surface, leading to uneven current delivery, arcing, and severe burns. Responders must use the pads in their original size and rely on the anterior-posterior positioning. After application, the pads should be firmly adhered to the bare skin to ensure a clean electrical connection before activating the AED for analysis.