Incorrect AED pad placement for lay responder First Aid/CPR/AED class

Adamsdaddy

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Greeting to all

I am a Red Cross Instructor who teaches mostly lay responder First Aid/CPR/AED classes along with some BLS, Wilderness First Aid and others. I'm looking for documentation if possible, or at least a definitive answer to a question that keeps popping up in class. I'm not an EMT or anything similar so my knowledge on the specifics of "why" is limited. I understand that commercial AED's will work if the pads are reversed (students who accidently put the pictured pads in their opposite places). I cannot find documentation through Red Cross or any searches that explain what exactly happens when the pads are placed on the upper LEFT shoulder and RIGHT side rather than the correct RIGHT shoulder, LEFT side. I understand the "why" with front to back pad placement and reversed pad placement but can't find info or specific documentation on why right shoulder, left side does or does not work. Will a commercial machine not read a rhythm correctly? Will it read but not deliver 100% of the shock to the heart do to the offset pad placement?

Any info that would help explain to students that have never even seen an AED why this does or does not work would be greatly appreciated.

Thank you so much for all you do.
 

hometownmedic5

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The biggest reason to not do that is implanted devices. Since the proliferation of public access defibrillation, cardiologists et al have stuck to the upper left chest for AICDs etc, since it was decided, right wrong or indifferent, to place defibrillator pads upper right chest and left mid axillary. Reversing them but maintaining laterality is irrelevant since the standardization of biphasic defibrillation.

The orientation of the heart is such that, as directed, the electricity travels through its long axis. More muscle in the line of fire so to speak, a high chance of the shock depolarizing more myocytes, leading to a better chance of a successful hard reset. Crossing the heart perpendicular to its long axis reduces the above.

I suspect the computer could sort out the difference in the ekg. I seem to recall AHA literature stating that, if put on backwards, the device would still work; but it’s been a long time since I was an instructor, or was present in a lay rescuer class. We don’t discuss the efficacy of doing things bassakwards much in pro rescuer, in my experience.
 

E tank

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In the hospital OR and different procedural labs, the pads are put anywhere they don't get in the way of the operation or x-ray imaging...as in both pads in nearly the same plane on the patient's back.

Definitely off label placement and would really surprise instructors that hammer correct placement. But they work just fine. But that's in a warm, oxygenated patient whose rhythm hasn't gone sideways for more than 30 seconds.

As an aside, I wonder the wisdom of getting too much into the "why's" of stuff without the context of more advanced training and experience. How do you explain @hometownmedic5 's excellent breakdown to a layman? Taken out of context, a little knowledge can be inadvertently and innocently weaponized, if you know what I mean.
 
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Adamsdaddy

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I teach way more "why" than "how". I can teach you how to change the clock on a sony VCR (showing my age here) but you may not understand how to do that with a different zenith VCR. I understand that there is a menu, up, down, enter, change, exit buttons. I don't really need to know how to do it because I understand why it does what it does and can mostly work it out. If I can tie in a connection instead of a list people tend to remember and connect with the answer. Rarely is "why" complex but rather helpful in understanding. Why is choking taught as a care now situation? Well, I'd rather you try to help the person breath as time is limited than to waste a minute or two running to your bag to get a phone. Those are the why's I shoot for. I couldn't give a good answer about the placement of pads. Reversed, anterior/posterior and classic placement I understand.

So to clarify E tank, you are saying that AED pads placed pretty much anywhere on the chest will shock the entire torso enough to make the shock effective? Hometownmedic5, Yes, classes are taught that reversed AED pads still work but is that the wrong pads in the correct positions or the correct pads in the wrong positions? My understanding is it's about the pads placed in the right locations (right shoulder on the left side spot and vice versa). This is the reason WHY helps me filter this down to people whom have never touched an AED in real life or in a training class. It helps me explain the answers when they come. Thanks again to all and any other information, especially any documentation you might have from a text book or source would be amazing!
 

Jambow

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the rhythms that the AED look at (v-tach and V-fib) look the same, either way the pads are placed. The pads read from one to the other (talk to each other) to identify the heart rhythm. if the pads are swapped in location the AED will still recognize the rhythm. Agreed- as long as there is not an implanted defiibrillarot or pacemaker in the upper left chest the pads on the Left vs Right will not matter. The AED will still see the same thing.
 

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Adamsdaddy

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So I received my answer. This comes from 2 doctors, a lot of you (thanks to all here and on other sites that helped) and 2 AED manufacturing companies. Ultimately it is about the electrical signal, in either direction, going through as much of the ventricles as possible. When the pads on a commercial AED are placed incorrectly on the upper left shoulder and the right side the electrical charge is not delivered through the entire heart but focuses more toward the atria and lesser on the ventricles depending on the actual placement of the pads. It MAY work but most likely will be less effective or ineffective in correcting ventricular tachycardia/fibrillation.

Please forgive me if my terminology is not completely accurate. I teach Red Cross First Aid, BLS and wilderness classes but I don't have further EMT training so this has been a wonderful learning curve for me. I will now filter this down to something that is easily understandable to someone who has never seen an AED. I've explained this in my class yesterday and both first time students completely understood WHY this is important and skipped over the technical stuff. I believe it made a difference.

Thank you all again for all you do. You inspire me and drive me to be better at what I do when I teach lay responders and professionals. My 27yr old son has switched his profession from computer coding to taking his very first class in Boston to become an EMT. I'm so excited for him in his choice.

Also, thanks who whomever told me to focus that the side AED pad actually goes on the side and not just on the top of the body (3D vs 2D pad placement). I have always taught this correctly but the last few classes I find I am really focusing on this small detail. It seems this is a bigger issue in real life (poor teaching maybe?) and I'm glad to focus on anything that makes your job easier and their life saving skills better.

Be safe, keep doing what you do and thank you all for your assistance with my question.
 

ffemt8978

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Thank you for researching, finding and posting an answer
Instead of bumping a thread to say thanks, please use the "Like" button instead.
 

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