- Defibrillation pads are used to facilitate cardioversion and defibrillation
- some allow ECG monitoring and external pacing
- paddles are becoming obsolete
- used to reduce transthoracic impedance when paddles are applied directly to the chest wall to deliver a shock.
- The packet containing the gel pads must not have been opened otherwise the pads may have dried out.
- The pads are for single patient use but can be used for multiple shocks during the same resuscitation attempt (? maximum number)
- The pads not only limit transthoracic impedance but also protect the skin from being burnt.
Multi-function electrode (MFE) pads or self-adhesive defibrillator pads/electrodes
- more commonly used
- allow monitoring, defibrillation and pacing without additional monitoring electrodes or the operator needing to come into direct contact with the patient
- The MFE pads provide a greater surface area for energy delivery, deliver more reliable charge, reduce the skin complications from current delivery and are safer for staff
- Transthoracic impedance seems to be similar whether gel pads or MFE pads are used
Paddle/ pad size
- larger size associated with higher success rates and less myocardial damage
- Paddles/pads of 10–13 cm optimally reduce transthoracic impedance
METHOD OF USE
There are two accepted positions to optimize current delivery to the heart:
- (1) Anteroapical – one pad/paddle is placed to the right of the sternum just below the clavicle, and the other is centred lateral to the normal cardiac apex in the anterior or midaxillary line (V5–6)
- (2) Anteroposterior – the anterior pad/paddle is placed over the praecordium or apex, and the posterior pad/paddle is placed on the back in the left or right infrascapular region.
In applying either gel pads or MFE pads there must be good contact between the pad and the skin (needs to be dry and clean) to enhance adherence and decrease the chance of arching/burns
- The skin should be shaved if needed
- The pad should not be in contact with any other equipment including ECG dots, GTN pads, lines and cables
When paddles are used the pressure exerted needs to be at least 50 Newtons
- Arcing (electricity travels through the air directly between electrodes and can result in explosive noises, burns and impaired delivery of current)
- Electrical injury to bystanders
- Risk of explosion if oxygen flow continues during shock delivery
- Skin burns from repeated shocks
- Myocardial injury and post defibrillation dysrhythmias and ‘stunning’
- Skeletal muscle injury
- Thoracic vertebral fractures
- Some defibrillators allow transcutaneous pacing using self-adhesive defibrillator pads