3.2 Special AED Situations: Water, Hair, Patches & Implanted Devices
Key Takeaways
Move a patient out of standing water and quickly dry the chest where the pads will adhere; the whole body does not need to be completely dry.
If heavy chest hair prevents pad adhesion, rapidly clip or shave only the pad sites or use a first pad to remove hair if the device kit supports that method.
Remove a transdermal medication patch at a planned pad site with gloved hands, wipe the skin, and place the pad on bare skin.
Do not put a pad directly over an implanted pacemaker or defibrillator generator; shift the pad enough to avoid the device.
Never delay external AED analysis or a shock while waiting for an implanted defibrillator to act.
3.2 Special AED Situations: Water, Hair, Patches & Implanted Devices
Most special AED situations require only a quick pad-site adjustment. The guiding rule is to solve the adhesion or safety problem without creating a long delay in analysis, shock delivery, or CPR.
Water and a wet chest
Do not operate an AED while the patient is lying in standing water. Move the person to a safer surface and quickly wipe the chest dry where the pads will stick. The arms, legs, hair, and clothing do not need to be completely dry before AED use.
Continue CPR while another rescuer prepares the chest. Water on the pad site can prevent adhesion and may allow current to track across the skin, so drying the contact area is the important step. Once pads adhere, clear everyone normally for analysis and shock.
Heavy chest hair
Pads must contact skin. If chest hair is light enough for the adhesive to seal, apply the pads without extra preparation. If dense hair prevents contact:
- Use clippers or the razor supplied in the AED kit to clear only the two pad areas, or
- If taught for the available device and a spare set is ready, press down the first pads and pull them off rapidly to remove hair, then apply fresh pads.
Do not spend time shaving the entire chest. If a pad is already firmly attached, leave it in place.
Transdermal medication patches
A medication patch under an AED pad can block adhesion and may contain conductive material. Wearing gloves, remove a patch located at the intended pad site, wipe away remaining medication, and apply the AED pad to bare, dry skin. Avoid direct contact with medication on the patch.
Do not remove patches elsewhere on the body when they do not interfere with pad placement. Move efficiently and resume the standard sequence.
Implanted pacemakers and defibrillators
An implanted pacemaker or cardioverter-defibrillator may create a visible or palpable bump, often beneath the skin of the upper chest. Do not place an AED pad directly over the generator. Move the pad enough to avoid the lump while keeping a suitable current path and ensuring the two pads do not touch.
An implanted defibrillator may deliver a shock. That does not make the external AED unnecessary. Do not wait 30-60 seconds or any other fixed interval for an implanted device. Apply the external AED promptly, clear the patient, and follow its analysis and shock prompts.
Oxygen and fire safety
Oxygen supports combustion. Follow the equipment instructions and local protocol to prevent oxygen from flowing across the chest during shock delivery. Keep oxygen tubing or a mask from resting directly over the pads. Do not delay ventilation or defibrillation with an unnecessarily elaborate equipment move; the team coordinates the oxygen source and clear command before shock.
Metal surfaces
An AED can be used when the patient is on a metal stretcher or similar surface, provided the pads are attached to the chest, do not touch the metal, and rescuers are clear during analysis and shock. Follow local equipment instructions. The presence of a metal surface by itself is not a reason to postpone defibrillation.
Pad placement conflicts
Use the standard adult anterolateral positions whenever they fit. If a device, wound, dressing, or pad-size conflict occupies the exact site, shift the pad enough to obtain full contact on intact skin. If pads would touch because the chest is small, use the device-approved anteroposterior arrangement.
Never place a pad over a medication patch, directly over an implanted-device generator, or where adhesive cannot contact skin. Never cut or fold a pad.
Efficient team approach
While the compressor continues CPR, the AED rescuer identifies the problem, requests the needed towel, razor, gloves, or spare pads, and prepares both sites. State the issue briefly—“drying pad sites” or “moving off implanted device”—so the team understands the delay. Pause only when the AED needs a motion-free analysis or when a shock is about to be delivered.
Common errors
- Drying the whole body instead of only the chest pad sites.
- Shaving more hair than needed.
- Touching medication on a removed patch with bare hands.
- Placing a pad directly over an implanted generator.
- Waiting for an implanted defibrillator before using the AED.
- Withholding the AED solely because the patient is on a metal stretcher.
The correct exam answer makes the smallest safe adjustment and then returns immediately to the normal AED sequence.
A patient in cardiac arrest has a wet chest after being removed from a pool. What should the AED rescuer do?
Wait until the entire body is completely dry
Place the pads over wet clothing
Quickly dry the chest pad sites, apply the pads, and use the AED
Withhold defibrillation
An implanted defibrillator is visible beneath the skin near the intended upper pad site. What is correct?
Wait 60 seconds for the implant to shock
Place the AED pad directly on the device
Use only one AED pad
Shift the pad enough to avoid the device and use the AED promptly
A medication patch lies exactly where an AED pad should go. What should the rescuer do?
Remove it with gloved hands, wipe the site, and apply the pad to bare skin
Place the AED pad over it
Move both pads to the same side of the chest
Stop CPR until a pharmacist arrives
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