[sfreders]

Today in my CPR/First Aid class we learned about AED's and how to use them. I have a patient that I take care of who has Parkinsons. He has two electrodes in his chest that send electrical waves to his brain to help him move better, one on each side of his chest. My question is this...if there was ever a situation where an AED might need to be used where would you place the pad on the right side at? The electrode on that side is in the spot where we were trained to put the pad at, and you aren't allowed to put the pad over the electrodes or pacemakers. My instructor was not able to answer this for me. Would you put it under his right nipple? Thanks I appreciate the feedback.

[WSU_Ally_RN]

I'm not sure where these electrodes are exactly located on this patient, but I would think you would place them as close to the correct position as you possibly could. You don't want to place them over his electrodes. Maybe place it crooked on his chest, not straight up and down, or just right below the electrode. That is at least what I think I would do. Maybe others on here have other opinions for you!

[sharrie]

Depending on the type of defibrillator there are alternative pad positions that can be used.

Auxilla / auxilla
or anterior posterior.

have a look here at the section on defibrillator pad positions and alternative positions
http://www.resus.org.uk/pages/als.pdf

[sharrie]

In answer to your question about under the right nipple this isnot something I would advise as the positions are aimed to get optimum electricity to the myocardium below the nipple would not meet this need and therefore the electricity would not get to where it is needed.

Also what i think you would need to question is what is the worst thing that can happen, if you are using the defibrillator he is in cardiac arrest, if you don't shock he will die, if you do there is a risk of some burns around the electrodes and the implants may fail but he has a chance of survival.

It is all about risk assessment

[flightnurse2b]

i would say anterior-posterior would be best for this pt. i agree with the PP that putting the pads near his nipple would not be delivering a very effective shock.

[RNREMT-P]

anywhere that the current will pass through the myocardium and avoid the device in his chest. I"d personally choose AP.
XB9S (who has an AWESOME motorcycle) put it best...it's all about risk assessment. What's the worst that can happen?

[oramar]

Originally Posted by XB9S

Depending on the type of defibrillator there are alternative pad positions that can be used.

Auxilla / auxilla
or anterior posterior.

have a look here at the section on defibrillator pad positions and alternative positions
http://www.resus.org.uk/pages/als.pdf

Nice link, am reading it with great interest. Thanks

[ecnav]

right (+) superior & left (-) inferior - approximate the net myocardial conduction vector - 60 degree axis?