# Pediatric pads on AED for adult CPR?



## AmbulanceRider (Aug 16, 2014)

I was talking with a co-worker today who insisted that it would not be a waste of time to use pediatric AED pads on an adult during CPR if adult pads are not available. I would assume the decrease in the amount of shock from the smaller pads wouldn't do much to help restart the heart and would just cause more interruptions is chest compressions. What do you think?


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## chaz90 (Aug 16, 2014)

This theoretical scenario is just silly. In what scenario would you have pediatric pads available but not adult? Honestly, anything on this would be purely speculative as it has likely never been researched.


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## drl (Aug 17, 2014)

Agree with chaz90. When someone asked about that unlikely scenario in my EMT class though, the instructor suggested that it would probably be a waste of time to use the ped pads. Unless he had a lot of spare hands on deck, he would continue CPR w/o the AED.


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## Handsome Robb (Aug 17, 2014)

While it may not be effective since most, if not all, AEDs reduce the energy delivered when the pediatric pads or pediatric key is inserted. I know some monitors sense impedance and adjust the dose accordingly but I'm not sure if AEDs do the same thing. 

With that said I would still attempt defibrillation on an adult with pediatric pads if it really was my only option. My reasoning is with good management peri-shock pauses can be <5 seconds which won't totally destroy any perfusion pressure you've built up. Also, defibrillation and CPR are the only things proven to work in cardiac arrest patients. If you're not going to defibrillate them how do you plan on converting the rhythm into a perfusing one?


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## Ewok Jerky (Aug 17, 2014)

I don't think it would work but I would try it. If I have a shockable rhythm and an aed someone is getting shocked.  (I told my supe the same thing when I was told that as a basic I cannot touch the lp12 in my rig while running bls)


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## MrJones (Aug 17, 2014)

Go ahead - use those pedi pads on an adult. Then start another thread describing all the legal issues you're facing because you either chose to ignore the standard of care expected by using the wrong equipment or failed to properly inspect your equipment resulting in not having the appropriate pads.


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## Ewok Jerky (Aug 17, 2014)

MrJones said:


> Go ahead - use those pedi pads on an adult. Then start another thread describing all the legal issues you're facing because you either chose to ignore the standard of care expected by using the wrong equipment or failed to properly inspect your equipment resulting in not having the appropriate pads.



I'm pretty sure this was a hypothetical scenario (ie academic exercise).

Plus I would rather explain why I tried pedi pads rather than no shock at all.


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## samiam (Aug 18, 2014)

beano said:


> I'm pretty sure this was a hypothetical scenario (ie academic exercise).
> 
> Plus I would rather explain why I tried pedi pads rather than no shock at all.


This, just imagine explaining oh yeah had a aed didnt even try because I had something that only might work. You have to adapt to the scenario and frankly I dont think making a good willed attempt and using peads pads would be seen as gross negligence. I would say go for it better it works and you might get a not dead person then do nothing and get a dead person.

*Not legal advice just an oponion


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## cprted (Aug 19, 2014)

This is a highly unlikely scenario ... however, if I was working a code and I had the choice between shocking with peds pads and not shocking at all, I'll use the peds pads.


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## sjukrabilalfur (Sep 1, 2014)

Maybe this is a dumb question, but would an AED hooked up to ped pads even read a shockable rhythm accurately on an adult?


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## Tigger (Sep 1, 2014)

beano said:


> I don't think it would work but I would try it. If I have a shockable rhythm and an aed someone is getting shocked.  (I told my supe the same thing when I was told that as a basic I cannot touch the lp12 in my rig while running bls)


Even though it has an AED mode? Wut.

Our LifePak pediatric pads have attenuators built into the cables, so they definitely cannot deliver the same energy. I'm not saying it wouldn't ever work, but there is a reason that manufactures have recommended adult energy levels.


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## Handsome Robb (Sep 2, 2014)

sjukrabilalfur said:


> Maybe this is a dumb question, but would an AED hooked up to ped pads even read a shockable rhythm accurately on an adult?


VF/VT is VF/VT whether they're 2 months old or 60 years old.


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## sjukrabilalfur (Sep 2, 2014)

Handsome Robb said:


> VF/VT is VF/VT whether they're 2 months old or 60 years old.


Very true. Only thing I was thinking of is, pad size and anatomical differences affecting the reading.


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## Handsome Robb (Sep 2, 2014)

sjukrabilalfur said:


> Very true. Only thing I was thinking of is, pad size and anatomical differences affecting the reading.



How would pad placement change anything? Electrophysiology is electrophysiology. How would anatomical differences change electrical signals outside of impedance?


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## sjukrabilalfur (Sep 2, 2014)

Handsome Robb said:


> How would pad placement change anything? Electrophysiology is electrophysiology.


Touché. I guess it's the same principle as using the same pair of adult pads on a patient who's 170 pounds or 370 pounds.


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## Christopher (Sep 2, 2014)

Handsome Robb said:


> VF/VT is VF/VT whether they're 2 months old or 60 years old.


Unrelated to the main topic...however, this is untrue in the case of VT.

Most automated interpretation algorithms apply a heuristic to the VT shape/speed to determine if it is likely pulsatile or not (no joke). When in pediatric mode they apply different heuristics.


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## WildlandEMT89 (Sep 2, 2014)

I doubt it would work. Based on current AED designs peds pads don't pump out the same as adults.
Your patient would have a better chance of a positive outcome if you continued CPR while awaiting a monitor or proper pads instead of hoping that the peds pads will work and stopping CPR to shock.


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## Handsome Robb (Sep 3, 2014)

WildlandEMT89 said:


> I doubt it would work. Based on current AED designs peds pads don't pump out the same as adults.
> Your patient would have a better chance of a positive outcome if you continued CPR while awaiting a monitor or proper pads instead of hoping that the peds pads will work and stopping CPR to shock.



So despite defibrillation being one of the only things to be proven to affect outcomes you wouldn't even attempt it? What if that monitor never comes?

Christopher, I didn't know that. Always dropping knowledge bombs on me, I appreciate it. Do you think the different heuristics would cause the AED to not shock VT in an adult with pediatric pads then?


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## WildlandEMT89 (Sep 3, 2014)

Handsome Robb said:


> So despite defibrillation being one of the only things to be proven to affect outcomes you wouldn't even attempt it? What if that monitor never comes?



Early and quality CPR is also something proven to affect outcomes.

In a situation where a monitor or alternate AED is not coming or is severely delayed I would have to agree that I have seen no evidence that using peds pads would be harmful. 
My thought process was that in a situation where your unit somehow ended up without adult pads, that your time would be better served giving adequate CPR until another unit arrives and they don't have to remove pads to attach proper ones and the patient is ready to shock immediately as they have been getting quality compressions for several minutes.

In any case there should not be a time when you are assigned gear and don't check it off.


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## Handsome Robb (Sep 3, 2014)

WildlandEMT89 said:


> Early and quality CPR is also something proven to affect outcomes.
> 
> In a situation where a monitor or alternate AED is not coming or is severely delayed I would have to agree that I have seen no evidence that using peds pads would be harmful.
> My thought process was that in a situation where your unit somehow ended up without adult pads, that your time would be better served giving adequate CPR until another unit arrives and they don't have to remove pads to attach proper ones and the patient is ready to shock immediately as they have been getting quality compressions for several minutes.
> ...



You're right, CPR is proven to improve outcomes but CPR itself is not going to convert the lethal rhythm, only electricity will, reliably with good outcomes that is. 

You're definitely right that you damn well better check your gear as well because if you don't and something like this happens say hello to a lawsuit. I had a partner that used to show up 30-45 minutes prior to our shift and would do a really thorough check of the unit but I'd still check certain things and they took it offensively until I explained that if a critical piece of equipment is missing and it affects patient care it's not their ***, it's mine and "but my partner checked the gear" isn't a viable excuse. Nothing personal bud but if I'm going to get hung out to dry it's going to be on my on mistake, not someone else's. 

Not trying to come after you, I apologize if I came off that way. After re-reading my post it definitely seems like it but that was not the intent, was wondering your thought process. I do agree with what you're saying but with good management of compressions/resuscitation efforts you can have a short per-shock pause but you've gotta be on top of it and the crews your working with have to trust you. The first time I did a rhythm check, saw coarse VF and told the FF to jump back on the chest while I charged the monitor he looked at me like I had two heads. As far as detaching and reattaching pads you can do it around the compressor without interrupting them provided you're using sternum and apex positioning of the pads. Anterior/posterior is a different story but personally I'd still try. Yea you have to stop compressions for a couple seconds and lose your perfusion pressure you've built to roll them, remove the posterior pad and replace it it's still something that can be done in less than 5-10 seconds. Remember, you don't have to be nice about removing the pad...they can't feel it  Plus it's like a bandaid, the faster you do it the less it'll hurt if they could feel it. 

The reason I say I'd use peds pads even if I knew another set was coming is that the earlier the first defibrillation is performed the better chance they have. 

Another one that no one has brought up...what about a precordial thump?  Probably won't work since you didn't witness the arrest and deliver it within a few seconds of the rhythm change but it doesn't cause any harm.


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## Christopher (Sep 3, 2014)

Handsome Robb said:


> Christopher, I didn't know that. Always dropping knowledge bombs on me, I appreciate it. Do you think the different heuristics would cause the AED to not shock VT in an adult with pediatric pads then?



If the device switched to pediatric mode, yes it may (depends on the device and its embedded algorithm).


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## WildlandEMT89 (Sep 3, 2014)

Handsome Robb said:


> Not trying to come after you, I apologize if I came off that way. After re-reading my post it definitely seems like it but that was not the intent, was wondering your thought process.



No worries, I always try and assume comments online are good Natured and with the best intentions as a lot tends to get lost In text. 
And it is nice to see your thinking as well.


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