Defibrillation uses a controlled electrical shock to reset the heart’s rhythm during life-threatening irregularities. It’s often necessary when the heart’s electrical activity becomes chaotic, as seen in conditions like ventricular fibrillation. While effective for adults, children present unique physiological considerations that require specialized equipment and approaches.
Understanding Pediatric Paddles
Pediatric paddles are designed for children, differing significantly from adult paddles in size and energy delivery. Children have smaller body surface areas and require lower energy doses for effective and safe defibrillation. Pediatric pads are smaller, fitting appropriately on a child’s chest without overlapping. They also come in different colors.
A difference lies in the mechanism of energy delivery. Pediatric pads are designed to reduce electrical energy from the defibrillator. This attenuation lowers the energy from typical adult levels of 150-360 joules to around 50-75 joules for children. This adjustment ensures the electrical shock is appropriate for a child’s smaller and more delicate heart, preventing potential harm from excessive energy. Modern AEDs feature a “child mode” or a specific key to adjust shock intensity when pediatric pads are connected, or allow universal pads with a child button for attenuation.
Guidelines for Pediatric Paddle Use
Determining when to use pediatric paddles depends on a child’s weight and age, as these factors correlate with body size and physiological maturity. Guidelines recommend using pediatric pads for children weighing less than 25 kilograms (approximately 55 pounds) or those under 8 years old. These criteria help ensure the electrical current is delivered safely and effectively through the child’s smaller body.
Proper placement of pediatric pads is also important for effective defibrillation. For infants and young children, an anterior-posterior placement is recommended, with one pad on the front of the chest and the other on the back, between the shoulder blades. This positioning helps ensure the electrical current passes through the heart without the pads touching, reducing effectiveness. Protocols for pad placement can vary depending on the device and the child’s size, but the underlying principle remains consistent: maximize current flow through the heart while minimizing risks.
Implications of Incorrect Paddle Size
Using the wrong-sized paddles on a child can lead to adverse outcomes, compromising defibrillation effectiveness and potentially causing harm. If adult pads are used on a child, the delivered energy might be excessively high, potentially causing burns to the skin or damage to the heart muscle and other internal organs. Adult pads are designed for a larger body mass and deliver a substantially higher electrical dose than a child needs.
Another problem with using adult pads on a child is the risk of ineffective shock due to improper placement. Adult pads are too large for a child’s smaller chest and may overlap. When pads overlap, the electrical current can short-circuit, flowing directly between the pads instead of through the heart, rendering the shock ineffective. This improper contact reduces the amount of current reaching the heart, potentially failing to correct the abnormal rhythm. Conversely, using pediatric paddles on an adult would deliver insufficient energy, as pediatric pads are designed to reduce the shock to levels too low for an adult’s heart, making the defibrillation attempt ineffective.