The methods of defibrillating an infant are basically the same as defibrillating a child. One important distinction involves AED pad size.
AED pads come in an adult size and a pediatric size, for patients less than 55 pounds or roughly 25 kilograms. For infants (around one-year-old or less), as they are considerably smaller than children, having the right pad size becomes even more important.
However, remember, if you do not have pediatric pads and the patient is less than 55 pounds, use the adult pads. It's far better to use the wrong size pads than it is to forego using an AED.
Also, remember that when using an AED, there are a couple of important things to keep in mind as it relates to your surroundings.
- Are there combustible gases or liquids at the scene?
- Are there any liquids that could connect the victim with yourself, the responder, or someone else, that could result in electrocution?
If for some reason the scene isn't safe enough to use an AED, drag or move the patient to a safer area where you won't have to worry about explosives or electrocution from water and then use the AED.
And one last reminder: It's OK if the victim or the victim's clothing is wet, as long as the chest area is dry and you or the victim aren't submerged in water or connected by it. And with infants, since one pad will be attached to the back, that area must also be dry.
How to Provide Care
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive.
Are you OK? Can you hear me? (With infants, shouting their name, if you know it, may help.)
If you don't get an initial response, place your hand on the infant's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps.
- Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions.
- Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc.
- Check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse.
- If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with your AED.
AED Technique for Infants
- Turn on the AED.
- Remove the patient's clothing to reveal a bare chest and back.
- Attach one AED pad to the infant's chest, carefully roll the infant on his or her side, and attach the second pad to the back. The pads should have a diagram on placement if you need a reminder.
- Plug the cable into the AED and be sure no one is touching the patient, including yourself. The AED should now be charging and analyzing the rhythm of the patient's heart.
- If the scene is clear and no one is touching the patient, push the flashing shock button. Then go right into CPR. It's OK to perform CPR over the pads, so don't worry about moving them.
- Draw an imaginary line across the infant's nipples and place two fingers on the lower part of the sternum in the center of the infant's chest. Your fingers should be perpendicular to their chest, meaning your knuckles are directly above your fingers during compressions.
- Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on infants, use only your fingers to supply the force for the chest compressions, and count as you perform them.
- Conduct compressions that go roughly 1.5 inches deep, or 1/3 the depth of the infant's chest, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
- Perform 30 chest compressions.
- Grab the appropriately-sized rescue mask and seal it over the victim's face and nose.
- Place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position.
- Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath.
- After one round of CPR, let the AED analyze the patient again. If the AED advises you to perform another shock, make sure no one is touching the patient and press the shock button.
- Go right back into CPR.
Continue this cycle of CPR, re-analyzation, charging, shock, back into CPR until help arrives, the patient is responsive and breathing normally, or the next level of care takes over.
A Word About AED Precautions
When using an AED, there are several precautions to keep in mind. Some of these may be obvious (and a repeat of what you've already learned in this course), while others may not be.
- Since alcohol is flammable, do not use anything with alcohol on it to wipe the patient's chest or back dry.
- While it's OK to use adult pads on a child, the reverse isn't entirely true, as pediatric pads may not deliver enough energy to defibrillate the patient.
- Do not touch the patient while the AED is conducting an analysis, as this may affect the analyzation process.
- Before delivering an AED shock, make sure no one is touching the patient or any of the resuscitation equipment.
- Do not use an AED if there are flammable or combustible materials or gases present, including free-flowing oxygen.
- Do not operate an AED inside a moving vehicle, as the movement can affect the analysis.
- Do not use an AED if the victim is in contact with free-standing water or in the rain. Move the patient first.
- Do not place AED pads on top of any patches or implantable devices. Remove patches first and adjust the pads as necessary to avoid devices like a pacemaker.