Automated External Defibrillators (AEDs) are portable medical devices that analyze heart rhythms and deliver an electrical shock to restore a normal heartbeat during sudden cardiac arrest. Administering this intervention quickly is effective, as every minute without defibrillation decreases the chance of survival. Proper AED pad placement is essential for the device’s effectiveness, ensuring the electrical current travels efficiently through the heart. Incorrect pad placement can reduce the shock’s impact and hinder the device’s ability to accurately analyze the heart rhythm.
Understanding Anteroposterior Pad Placement
Anteroposterior (AP) pad placement positions one AED pad on the front (anterior) of the body and the other on the back (posterior). This differs from the more common anterior-lateral placement, where both pads are on the front of the chest, one on the upper right and one on the lower left. While anterior-lateral is standard for adults, the anteroposterior method offers an alternative when standard placement is not feasible or optimal. This configuration ensures the electrical current passes directly through the heart, which is important for effective defibrillation.
Anteroposterior placement is chosen when chest obstructions exist, such as medical implants (pacemakers or ICDs) or significant breast tissue. Placing a pad over an implanted device could damage it or divert electrical energy from the heart. This method also avoids pad overlap on smaller adult chests, ensuring sufficient separation for optimal current delivery. Research suggests anteroposterior placement can offer superior outcomes in some out-of-hospital cardiac arrest cases compared to anterior-lateral placement.
Precise Anteroposterior Pad Placement for Adults
For precise anteroposterior pad placement on an adult, specific anatomical landmarks guide pad positioning to ensure the electrical current effectively traverses the heart. The anterior pad is placed on the left side of the chest, generally between the midline and the left nipple. For female patients, place this pad below the breast tissue, often by lifting or moving the breast, to ensure direct skin contact and avoid shock interference.
The posterior pad is positioned on the patient’s back, directly behind the heart. Place it to the left of the spine, just below the left shoulder blade (scapula), at heart level. The posterior pad should be directly opposite the anterior pad, creating a clear pathway for the electrical current through the heart. Manufacturers often provide diagrams on the pads or AED device to illustrate these placements, guiding the rescuer. Ensuring both pads firmly adhere to the skin, without air pockets, is essential for efficient energy delivery and to minimize skin burns.
General Considerations for AED Use
Beyond correct pad placement, several other considerations are important for effective and safe AED use. Before applying pads, ensure the patient’s chest is bare and dry. Moisture can interfere with pad adhesion and electricity conduction, potentially leading to burns or ineffective shocks. If excessive chest hair is present, it may need removal for pads to adhere firmly. Many AED kits include a small razor for this.
Check for medication patches or implanted medical devices, such as pacemakers, on the patient’s chest. If a medication patch is present where a pad needs placement, remove it and wipe the area clean. When an implanted device is present, place the AED pad slightly away, about an inch, to avoid shocking the device.
Always use adult-sized pads for adult patients; these are designed to deliver the appropriate energy level and cover sufficient surface area. Once pads are applied and connected, follow the AED’s voice prompts. These prompts guide the user through heart rhythm analysis, advise if a shock is needed, and prompt for continued cardiopulmonary resuscitation (CPR). Minimize CPR interruptions, pausing only when the AED analyzes or delivers a shock.