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.
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.
