Which item is a special consideration when using an AED?

• A. Implanted defibrillators/pacemakers
• B. Water
• C. Transdermal patches
• D. Excessive chest hair

Answer: (A)

Implanted defibrillators and pacemakers are a key special consideration when applying an AED. The external shock energy can interact with the device, potentially causing inappropriate sensing, pacing changes, or device malfunction. To minimize risk, avoid placing AED pads directly over the implanted device; position the pads so the current path bypasses the device (for example, one pad on the right upper chest and the other on the left side below the armpit). This allows the rhythm disruption needed for resuscitation to occur without delivering energy directly into the device. In the heat of an emergency you still deliver shocks if indicated, but you don’t delay for assessment of the implanted device, and you may adjust pad placement to avoid the device as needed. A quick note: water increases danger to the rescuer and can cause current to spread; transdermal patches can cause burns or interfere with pad adhesion; chest hair can impede pad contact. However, the essential special consideration specific to AED use is avoiding placing pads over an implanted defibrillator or pacemaker.