Defibrillation question

Nurses General Nursing

Published

As seen in a commercial for an upcoming TV show episode ---- hospital scene, pt laying (lying?) flat in bed/stretcher, side rails down (OK). Male MD/nurse (?) with defib paddles in hand, paddles positioned over sternum/left lateral chest (OK-ish), ready to fire.

Here's the kicker --- pt in a hospital gown, no gel pads; therefore the defib firing attempt would be thru the gown!!??!!??

Now it's been eons & eons since I last used a defibrillator, but don't you still have to make direct contact to the gel pads on the bare chest? Not thru fabric? Uhhhh - i'is there something new out there in defibrillator land? Or did I just see another DUMB incorrect

over-dramatized made-specially-just-for-TV spectacle?

We used chest gel pads for AED training, so wouldn't this be applicable to general defibrillation also. I love catching medical bloopers on TV, so this just jumped out at me!

So... did I catch a blooper? Thanks.

In my hospital- Penn State Milton S Hershey Medical Center- we have removed the paddles completely from all defibrillators. We only use patches at this point for staff safety. But you CANNOT use the paddles without the "orange cheesy stuff" aka the gel. It doesn't conduct well enough.

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F a razor. If someone is pulseless, you put on a set of pads and rip them off, thus leaving a perfectly hairless spot for the next set of pads to defib.

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Specializes in Emergency Department.

You can use ultrasound gel if necessary. It's supposed to be very conductive as it's also used when e-stim is combined with ultrasound for certain types of physical therapy. That being said, I much prefer the hands-off method of using the pads instead of the paddles.

To the OP, you have to remember that television has a bit of censorship that they must do to keep things appropriate. While we are supposed to bare the chest when cardioverting, if the "patient" is female... that won't go over well with the FCC. So, they just grab a set of paddles and turn toward a gowned "patient." Welcome to television.

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You sure did, they always have bloopers like that and I think it's pretty funny.. ESpecially when they "defibrillate" and the patient jumps 2 feet in the air. lool

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Specializes in retired LTC.
You sure did, they always have bloopers like that and I think it's pretty funny.. ESpecially when they "defibrillate" and the patient jumps 2 feet in the air. lool
I seem to be moving this thread off-track again. Your post reminded me of other old TV movies/series when they would do psych ECT/EST. Again, the pt would fly up off the bed/table.

Even more eons waaaaay back, I remember attending a few ECT tx as a student. Tx was very subdued, low-key - like the pt just twitched with a 'chill' or in a bad dream. Nothing so TV-dramatic!

To responding posters out there - please know that I was just potificating on the silly blooper I saw on TV. However, it DID spur my legitimate question re defib paddles & pads & chest contact, so I asked. I do thank y'all for answering. I am truly aware of the media's need to sensationalize for a ratings boost.

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In our ER we have lot's sets of pads available (although I'm not sure how it is in other units) and...well...cost never seems to be an issue during a code (but that is a different discussion).

LOL, no, I didn't mean to imply that cost should be an issue during a resuscitation attempt!

Most nurses who work in hospital EDs probably don't have to even think about cost or availability of supplies, but in my spare time, I volunteer for a small nonprofit prehospital outfit, and cost is definitely an issue (I am keenly aware of costs, as I order medical supplies). Razors are much cheaper than defib pads, and we keep a disposable razor in our Lifepak for this purpose.

Also, the method of using a defib pad to remove excess hair is unreliable, and in my opinion, shouldn't be taught. With most hairy chests, you will get good contact if you simply apply firm pressure when applying the pads. If the person is hairy enough that this is ineffective, ripping off the pad is unlikely to result in enough hair removal to be effective.

Lastly, keep in mind that many AEDs in public settings for the lay rescuer, like in the airport or shopping mall, only have one set of pads.

To the OP, sorry for the hijack!

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Dry shave with a disposable razor, or use clippers if your facility supplies them. Good skin contact is essential for effective defibrillation, and a little razor burn is the least of a pulseless person's worries.

Razor burn is the least of the problems. You can use the heaviest gel pad in the world, and patients still get at least a bit scorched--sometimes worse than a bit.

Yes I think a perfusing rhythm is better than razor burn or even some chest scorching. LOL

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LOL, no, I didn't mean to imply that cost should be an issue during a resuscitation attempt!

Most nurses who work in hospital EDs probably don't have to even think about cost or availability of supplies, but in my spare time, I volunteer for a small nonprofit prehospital outfit, and cost is definitely an issue (I am keenly aware of costs, as I order medical supplies). Razors are much cheaper than defib pads, and we keep a disposable razor in our Lifepak for this purpose.

Also, the method of using a defib pad to remove excess hair is unreliable, and in my opinion, shouldn't be taught. With most hairy chests, you will get good contact if you simply apply firm pressure when applying the pads. If the person is hairy enough that this is ineffective, ripping off the pad is unlikely to result in enough hair removal to be effective.

Lastly, keep in mind that many AEDs in public settings for the lay rescuer, like in the airport or shopping mall, only have one set of pads.

To the OP, sorry for the hijack!

Good for you Stargazer! Yes, when you move outside the hospital setting, you realize how big a deal (expense-wise) everything is. It kind of makes you think about how much you wasted stuff in the hospital in comparison.

You know this is a good question. You are out and someone drops. Someone that is super hairy. All you have are the one set of pads from the AED. I guess you do the best you can, b/c who is going to be carrying a razor or something to wax with, and time is the MAJOR factor for defibrillation.

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It is a good question. They do include razors in many AEDs, but if not, you should apply firm pressure when placing the pads. If the AED can analyze the rhythm, then you've made good contact.

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I have seen kits w/o razors. I agree, firm pressure and listen for analyzing. . .

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Specializes in Complex pedi to LTC/SA & now a manager.

Current training recommendations are to include gloves, pocket mask & razors in AED kits. Many AED's are sold with kits that include these items (pads, razor, gloves, and simple pocket mask) to increase potential for lay resucer use. Supposedly no added cost than just buying the pads.

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Specializes in Med-Surg, Emergency, CEN.

I watch Scrubs (slapstick comedy!) and want to know why the MDs are passing meds, hanging IVs, placing foley caths and feeding/turning/washing patients. I'm not even going to start on why a walking/talking 12 year old in street clothes is a patient in the ICU. I guess walking in, writing orders and walking out is not as entertaining... :sarcastic:

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