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Re: [ekg_club] AED Pad Placement

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  • PMATERAMD@aol.com
    hi Kat, how are you, just like the last ecg club discussion concerning effective treatment it really doesn t matter where the pads are placed as long as the
    Message 1 of 7 , Mar 4, 2008
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      hi Kat, how are you, just like the last ecg club discussion concerning effective treatment it really doesn't matter where the pads are placed as long as the depol energies are able to reach and penetrate the myocardium, so by default the shortest distance that will place the heart between the pads should work best at lower energy, many times we placed pads just right of sternum and just left of the TS, remember the goal of defib/cardiovert is to induce asystole to suppress all automaticity and then the intrinsic pacer best at being a pacer is the SA node and hopefully that is the next beat you see, if not then AV, then HPS then VT again, also remember if you actually are successful in breaking VT with cardioversion and then immediately go back to VT, 1) make sure it's not ST with BBB, then make sure you have addressed hypoxia, K+, pH, etc
       
      stay safe
      Paul
       
      Paul Matera, M.D., D-EM, D-IM, EMTP
      Attending Physician, Police and Fire Clinic, Washington, DC
      Director Emeritus, Critical Care Units, Providence Hospital, DC
      Clinical Associate Professor, George Washington University, DC
      Medical Director/Reserve Officer, Maryland NR Police and STAR Team
      In a message dated 3/4/2008 4:07:12 P.M. Eastern Standard Time, KPCRP@... writes:
       

       Question from a former student of mine -  and I can't answer it.  Is there such a thing as mid-axillary placement of pads on BOTH sides of the chest?  Has anyone ever heard of this?
       
      I have not seen the actual page (I don't have the latest copy), but apparently one Brady Basic textbook shows placement of the pads on both the left and right mid-axillary/ V-6 placement, instead of the right at the sternum (or standard A/P placement).
       
      Any help would be appreciated!
       
      Thanks,
       
      Kat Rickey



       
       



    • KPCRP@aol.com
      Thanks guys... I knew someone would know! Am sort of chagrined I didn t know about this after all these years, but...hey! we all keep learning. Right?
      Message 2 of 7 , Mar 4, 2008
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        Thanks guys... I knew someone would know!  Am sort of chagrined I didn't know about this after all these years, but...hey!  we all keep learning.  Right?  Right!  <GRIN>
         
        Kat
        (Hi, Doc/Paul!)



      • Nikiah Nudell
        I agree with those guys. You could put the pads anywhere that you can also get an ecg tracing. The main issue is the threshold required. The biphasic units
        Message 3 of 7 , Mar 4, 2008
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          I agree with those guys. You could put the pads anywhere that you can
          also get an ecg tracing. The main issue is the 'threshold' required.
          The biphasic units adjust for impedance (resistance). So you could
          possibly exceed the capacity of the unit to put out the joules. Better
          positions will give better results.

          Cheers
          Nick


          On 3/4/08, KPCRP@... <KPCRP@...> wrote:
          > Thanks guys... I knew someone would know! Am sort of chagrined I didn't
          > know about this after all these years, but...hey! we all keep learning.
          > Right?
          > Right! <GRIN>
          >
          > Kat
          > (Hi, Doc/Paul!)
          >
          >
          >
          > **************It's Tax Time! Get tips, forms, and advice on AOL Money &
          > Finance. (http://money.aol.com/tax?NCID=aolprf00030000000001)
          >


          --
          ----------------------------------------
          Nikiah Nudell
          www.safetechsolutions.us
          www.ekgclub.com
          www.linkedin.com/in/medicnick
        • Rangamani Murthy
          Hi Paul How are yoou doing? when are you coming back?rangu PMATERAMD@aol.com wrote: hi Kat, how are you, just like the last ecg club discussion
          Message 4 of 7 , Mar 4, 2008
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            Hi Paul How are yoou doing? when are you coming back?rangu

            PMATERAMD@... wrote:
            hi Kat, how are you, just like the last ecg club discussion concerning effective treatment it really doesn't matter where the pads are placed as long as the depol energies are able to reach and penetrate the myocardium, so by default the shortest distance that will place the heart between the pads should work best at lower energy, many times we placed pads just right of sternum and just left of the TS, remember the goal of defib/cardiovert is to induce asystole to suppress all automaticity and then the intrinsic pacer best at being a pacer is the SA node and hopefully that is the next beat you see, if not then AV, then HPS then VT again, also remember if you actually are successful in breaking VT with cardioversion and then immediately go back to VT, 1) make sure it's not ST with BBB, then make sure you have addressed hypoxia, K+, pH, etc
             
            stay safe
            Paul
             
            Paul Matera, M.D., D-EM, D-IM, EMTP
            Attending Physician, Police and Fire Clinic, Washington, DC
            Director Emeritus, Critical Care Units, Providence Hospital, DC
            Clinical Associate Professor, George Washington University, DC
            Medical Director/Reserve Officer, Maryland NR Police and STAR Team
            In a message dated 3/4/2008 4:07:12 P.M. Eastern Standard Time, KPCRP@... writes:
             
             Question from a former student of mine -  and I can't answer it.  Is there such a thing as mid-axillary placement of pads on BOTH sides of the chest?  Has anyone ever heard of this?
             
            I have not seen the actual page (I don't have the latest copy), but apparently one Brady Basic textbook shows placement of the pads on both the left and right mid-axillary/ V-6 placement, instead of the right at the sternum (or standard A/P placement).
             
            Any help would be appreciated!
             
            Thanks,
             
            Kat Rickey



             
             







            Never miss a thing. Make Yahoo your homepage.

          • nweers
            I haven t read all the blogs, but I do recall reading a research article on defib pad placement published in the NEJM quite a while back and one of the
            Message 5 of 7 , Mar 5, 2008
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              I haven't read all the blogs, but I do recall reading a research
              article on defib pad placement published in the NEJM quite a while
              back and one of the positions was the bilateral midaxillary position
              which had surprisingly successful defibrillation and cardioversion
              results. Good luck!!

              Neal

              --- In ekg_club@yahoogroups.com, KPCRP@... wrote:
              >
              > Thanks guys... I knew someone would know! Am sort of chagrined I
              didn't
              > know about this after all these years, but...hey! we all keep
              learning. Right?
              > Right! <GRIN>
              >
              > Kat
              > (Hi, Doc/Paul!)
              >
              >
              >
              > **************It's Tax Time! Get tips, forms, and advice on AOL
              Money &
              > Finance. (http://money.aol.com/tax?NCID=aolprf00030000000001)
              >
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