Special Situations Related to Automated External Defibrillation
The patient is in water. Water is a good conductor of electricity.Do not use an automated external defibrillator (AED) in water.Defibrillation administered to a patient in water could result in shocking the AED operator and bystanders. Another possible effect is that water on the patient's skin will provide a direct path for the electrical current from one electrode to the other. The arcing of the electrical current between the electrodes bypasses the heart, resulting in the delivery of inadequate current to the heart. If the patient is in water, pull the patient out of the water. If water is covering the patient's chest, quickly dry the chest before attaching the AED pads. If the patient is lying on snow or in a small puddle, the AED may be used after quickly wiping the chest (AHA, 2020b).
The patient has an implanted pacemaker or defibrillator. If possible, avoid placing the AED pad directly over the implanted device (AHA, 2020b), which will appear as a hard lump (from the size of a silver dollar to half the size of a deck of cards) beneath the skin of the upper chest or abdomen with an overlying scar. If an AED electrode pad is placed directly over an implanted device, the device may block delivery of the shock to the heart.
A transdermal medication patch is located on the patient's skin where the electrode pads are to be placed. Avoid placing AED pads in contact with or on top of a medication patch. The patch may block the delivery of energy to the heart and cause small burns to the skin. If it will not delay shock delivery, wear gloves or other barrier (to avoid transfer of medication from the patch to you) to quickly remove the patch and wipe the area before attaching the AED pad (AHA, 2020b).