CPR: Defibrillation with an AED on a child and an infant

Authors: Rednenko V.V., Rednenko L.I.

Editor: Rednenko V.V.

Equipment for the practical skill:

• protective medical gloves;
• СPR simulator "Infant";
• AED
• pediatric AED pads.

Clinical situation:

While at the train station, you heard a call for help. As you approached the scene, you found a group of people surrounding an infant lying on the floor. First responder beside the casualty asks you to bring a bag-mask device and an AED from medical station. You delivered the devices to the scene of the incident. First responder is performing chest compressions. You should give the infant defibrillation using the AED.

Order of the skill performance:

• Place the AED next to the infant.
• Open the case
• Turn the device on by opening the lid or pressing the power button

• Wait for the signal that the AED is operational and ready for use (Voice command “Device is on”).
• Remove or cut away clothing and undergarments to expose the infant’s chest.

• If the person’s chest is wet, dry it using a towel or gauze pad. Do not use an alcohol wipe to dry the skin.
• Follow the device’s directions.
• Apply the AED pads.
  • Open the AED pads.

• • Peel the backing off the pads as directed, one at a time, to expose the adhesive. 
  • Apply one pad on the upper right chest above the breast. For infants, apply on the front of the chest.

• • Apply the second pad on the lower left chest below the armpit. For infants, apply a second pad to the back.

• Ensure wires are attached to the AED box. Plug the connector cable into the AED (if necessary).

• After the device’s direction to analyze the heart rhythm (option “Rhythm  analyzing. Do not touch the patient”) ensure that no one should touch the person while the AED is analyzing the heart rhythm (option: say “Clear" loudly).

• If the AED message reads “Check Electrodes,” then:
  • Ensure electrodes make good contact.

• Follow one of options of the device’s directions:
  • If a shock is indicated (option:  “Shock required, do not touch patient. Press the “shock” button”), ensure that nobody is touching the victim (option: say “Clear" loudly). Push the shock button as prompted.

• • Resume CPR starting with chest compressions

• • If no shock is indicated (option: “No need for shock. Continue CPR”), immediately restart CPR with chest compressions.
  • If restoration of heart rhythm is determined (option: “Rhythm restored”), check infants’s breath. If you notice an obvious sign of life, stop CPR but leave the AED turned on and the pads in place on the infant’s chest, and continue to follow the AED’s prompts.