Placement of AED with a pacemaker

Hi all,
I went back to work and was talking with the school nurse who was concerned about the correct placement of the defibrillatort if she ever needed to use the AED on me. My Medtronic MRI safe pm is only a pm, would she use the "normal" position or would she need to use a sandwich method? I called medtronics and they could not give me a clear answer so I thought that I would ask the experts!

Thanks

5 Comments

Placement

by Grateful Heart - 2015-01-06 10:01:56

If possible, trying to place the pads not directly on the PM would be preferable. However, in an emergency, obviously the main idea is to get the heart beating or back into normal rhythm. As per my AHA Certified CPR instructor.

If we are in need of a defib, we can't be choosy at that point.

I find it disturbing that Medtronics could not give you an answer. I would call back and ask another person. If they still can not give you an answer, I would speak to a Supervisor and ask them. That just doesn't sound acceptable coming from the device company....scary but not at all surprised. jmo

Grateful Heart

Google will answer the question...

by donr - 2015-01-07 02:01:43

...just ask it where to put the paddles.

EDITED IT AFTER POSTING AND COMING BACK TO READ IT AGAIN

Begin Edit:
As a PM/ICD host, this sort of problem should be straightforward & duck soup to us. We know WHERE a PM is located (Generally - unless it is on the right side or in the abdomen or sub-pectorally planted). We also know we don't want to fry someone's PM/ICD w/ a jolt of several joules of energy.

I recommend that everyone go read the instructions for using an AED - just ask Google for "AED Instructions for use."

Then stop & think: will you REALLY have the time to do all the things they want you to do before applying the jolt. That is if you want the person to survive w/o brain damage. Supposing you are in a large shopping mall w/ hundreds of people around. You see a person grab something & collapse & fall unconscious. Sparrow can describe what it looks like. Probably from both sides of the incident.

EXACTLY WHO is going to know exactly where the AED is located? Probably the person best qualified to use it & they take off running to get the device, leaving the victim alone w/ a bunch of folks who haven't the foggiest notion of what to do. Also, face one other fact - the probability of the device being close by is pretty darned remote, so it's not going to show up w/i the first minute or two.

Then you have to read the instructions - another panic-driven episode. Then expose the chest - try that on an unconscious man 6'4" tall. 250 lbs. Even try it on a 125 lb woman (She'd better be unconscious). Ever try to rip open a simple man's cotton undershirt? Call for Arnold Schwartzenegger for that chore. Try a nylon slip - you'll learn why nylon is the stuff of parachutes & rip-stop tents for backpackers. Consider if it's a woman wearing a skirt over that slip; well guys (Male & female varieties), now you're going to have the victim nearly naked on the floor of a mall. Wearing a coat & tie? Good luck at getting through all that material quickly - Oh, & you're supposed to be doing CPR on the victim all the while. Good luck w/ that, also.

Oh, & I forgot - this male type guy lying on the terazzo floor of the mall is an ex-Bulgarian Olympic weight lifter (my cardio's favorite example for just about anything) w/ more hair on his chest than an Alaskan Musk Ox in the dead of winter. Now we have to lather him up & shave him. Oh, JOY!

And we are worried about how to apply the paddles????? As a matter of fact, it should be intuitive for all of us reading this note. But you are going to have to make decisions on many issues - remember "Seconds Count."
End Edit

Here's a Q&D (Quick& Dirty ) summary of the rest of the answer - plus an explanation & some reasons why & Why not.

!) The heart sits kinda cattywompus in the chest. Right Atrium is just a tad to the RIGHT of the center line of rib cage, as defined by center of sternum. We also know from our own PM/ICD implants that it's about 3" down from the collarbone.

2) The bottom of the heart (Called the Apex, or more correct technically "The Pointy end.") is about two ribs up from the bottom on the left side of the rib cage.

3) The Defib lead from an ICD is implanted in the bottom (Apex) of the RIGHT Ventricle.

4) The Defib charge is applied between the Apex & top of the heart.

5) The PM/ICD is placed ABOVE the heart, just below the collarbone on the LEFT side of the body.

6) You do NOT want the AED charge to be applied ACROSS the PM.

7) Therefore, the RIGHT handed paddle goes at the bottom of the ribcage on the LEFT side of the patient about where they put the bottom sticky pad for an ECG.

8) The LEFT handed paddle goes just below the collarbone on the right side of the chest, close to the Sternum.

9) You press down HARD to ensure good electrical contact, & yell "Contact, stand clear of the air screw" as you press down. Face it, the arms & legs might flail, you don't know & you don't want to get kicked or punched by the victim. The AED does all the rest.

10) Does this sound complicated? It really isn't. The patient is lying on the ground - they sure as Heck aren't going to be standing! Your LEFT hand naturally lines up w/ the right upper side of the patient; your RIGHT hand naturally lines up w/ the left side of the patient. ALL you have to remember is the orientation of a human heart & where the paddles should be. Even THAT is a natural thing. You will not be straddling the patient - you will be at their side. Just remember to be on the RIGHT side & all will be fine. Your right hand will be a body's width away from your left hand. That puts it toward the bottom of the heart.

11) Don't worry about being wrong or slightly off in positioning. Seconds Count.

12) Why this? The PM/ICD is well off a straight line drawn between the two paddles since it is near the LEFT collarbone. The whopping current flows in essentially THAT straight line, so the PM/ICD is safe. The current flows through the heart from bottom to top, just like in the case of an ICD firing.

13) BTW: Most states have a "Good Samaritan" Law protecting non-professionals from suit in the event something doesn't work out. It is better to try & fail than to stand there & do nothing while watching someone die.

Donr

Thanks

by Bean19 - 2015-01-07 06:01:05

Thank you everybody for the thoughts!

sunny

by Tracey_E - 2015-01-07 08:01:12

I just got certified again a couple of months ago. Lots of changes to the CPR part if you haven't done it recently, but AED hasn't changed. Ideally put the pads to the side of the device but if they are using an AED on us, we are DEAD so whatever it takes to get the heart beating is ok.

It's nice to have people trained and imo everyone should be CPR and First Aid certified, however, seconds count in an emergency so AED's are intended to be used by someone untrained. They're basically fool-proof. Turn it on and it tells you very precisely what to do and when.

I'm really surprised someone at Medtronics didn't know this!! It's pretty basic.

if you put the pads on top of the device...

by Tracey_E - 2015-01-07 08:01:24

It's not going to hurt the device, it's not going to hurt us, but there's a chance the shock won't be as effective. Ideally, put the pads off to the side of a device. Practically, speed is more important than perfection so slap those suckers on and tell the AED machine you're ready for the next step. If you are using an AED, the heart has stopped and the person is not breathing. Just do it.

You know you're wired when...

You have the perfect reason to show off your chest.

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