An Automated External Defibrillator (AED) is a portable device that delivers an electrical shock to individuals experiencing sudden cardiac arrest. This occurs when the heart’s electrical activity becomes chaotic, preventing it from effectively pumping blood. An AED analyzes the heart’s rhythm and, if a shockable rhythm is detected, delivers an electrical impulse to restore a normal heartbeat. Prompt AED application significantly increases survival chances by interrupting irregular electrical activity and allowing the heart to re-establish an organized rhythm.
Understanding Anterolateral Placement
Anterolateral placement is the standard positioning of AED pads on an adult’s chest, ensuring the electrical current passes effectively through the heart. This method involves placing one pad on the upper right side of the chest and the other on the lower left side. This specific configuration creates an optimal pathway for the defibrillation energy to traverse the heart muscle.
Step-by-Step Pad Application
For anterolateral placement, one AED pad is positioned on the upper right side of the chest, just below the collarbone, to the right of the breastbone. The second pad is then placed on the lower left side of the chest, several inches below the armpit, below the left breast.
Before applying the pads, expose the patient’s bare chest by removing all clothing, including bras. Each AED pad typically features diagrams illustrating the precise placement locations, which should be followed carefully. After placing the pads, firmly press them onto the skin to ensure complete contact, eliminating any air bubbles. Maintaining good skin contact is essential for the effective delivery of the electrical shock.
Why Specific Placement Works
The effectiveness of anterolateral pad placement stems from its ability to create an optimal electrical pathway through the heart. When the pads are positioned as described, the electrical current travels from the upper right side of the chest, through the heart, and exits through the lower left side. This trajectory maximizes the amount of electrical energy that reaches the heart muscle, which is essential for interrupting life-threatening rhythms like ventricular fibrillation. Proper pad placement reduces resistance to current flow, known as transthoracic impedance, thus increasing the chances of successful defibrillation. The goal is to encompass the heart within the electrical field created by the pads, ensuring the shock can reset the heart’s electrical activity.
Key Considerations During Placement
Several factors require attention during AED pad application to ensure effectiveness and safety. If the patient has a very hairy chest, the pads may not adhere properly, reducing shock efficiency. If a razor is available in the AED kit, quickly shave hair from the pad areas; otherwise, firmly pressing the pads can help improve contact.
If the patient is wet, they should be moved to a dry surface, and their chest quickly dried before pad application, as water can disperse the electrical current.
Patients with implanted medical devices like pacemakers or implantable cardioverter-defibrillators (ICDs) require careful pad placement. Do not place pads directly over these devices. Position AED pads at least one inch (2.5 cm) away to avoid interference and potential damage.
Remove any medication patches from the chest area with a gloved hand and wipe the skin clean to prevent burns and ensure proper conductivity. Ensure no one is touching the patient when a shock is delivered to prevent injury.