An arrhythmia is a disorder of the heart rhythm. This means that your heart beats too fast, too slowly, or with irregular frequency—most arrhythmia results from problems in the electrical system of the heart. If the arrhythmia is severe, one of the following two devices may need to be implanted directly under the skin: a pacemaker or an implantable automatic defibrillator (ICD). A pacemaker monitors electrical impulses in the heart. If necessary, it delivers electrical impulses to make it beat at a more normal pace. A pacemaker may be useful when the heart beats too slowly or at an abnormal rate. An ICD is a device that monitors the heart rate and, in case of problems, generates shocks.
How to know if the victim is carrying a pacemaker?
The case of a pacemaker (about the size of a lighter) is usually implanted under the skin below the clavicle (in the pectoral area), which makes it visible (there is a small rectangular bulge just under the skin or the presence of a scar).
What to do then?
If you ever have a cardiac arrest victim with a pacemaker, you will have to use a defibrillator, which will analyze the artifacts created by the pacemaker and determine if a shock needs to be delivered.
Nevertheless, care must be taken to ensure that the electrodes are not placed directly on the pacemaker. Any metal implant in the body creates a risk during defibrillation; this also applies to the metals of certain prostheses!
What to do if the victim is wearing a medicated patch?
If the victim wears, on the area of placement of the electrodes, a medico-adhesive stamp (also called “transdermal patch”), that is to say, a patch of nitroglycerin, for example, the rescuer must remove the patch (to avoid possible explosion hazards) and wipe the area before sticking the electrode.
- Metal surfaces “do not pose a shock hazard for rescuers.”
An AED can be used on a metal surface, such as a stretcher, the floor of a helicopter, or a boat. Care must be taken to ensure that the electrodes are not in contact with the metal and that no one is touching the patient when the shock button is depressed.
If possible, the rescuer moves the victim to a nonmetallic surface or slips a tissue (or blanket) under his body before beginning defibrillation.
- AED can be safely used in rain and snow, but the model must be suitable for this purpose (its Protection Rating must be high). However, if possible, it is best to take shelter and keep the victim protected from the elements.
If the victim is lying on wet ground (by the sea, by the pool, in the rain …) or if his chest is wet (damp or rainy weather), the rescuer should, if possible, move the victim to lengthen it on a dry surface and wipe its chest before placing electrodes.
Other general precautions to respect:
- Only use an AED on a patient who does not respond, does not breathe, and has no pulse.
- Do not touch the victim while the shock is being delivered by the device, so as not to disturb the heart rate analysis. Plus, you or someone else could be electrocuted.
- Do not use alcohol to clean the victim’s chest dry: alcohol is flammable !!
- Do not touch the victim while an AED is in the analysis phase. Feeling or moving the victim can affect the victim.
- Do not deflate anyone who is near flammable materials such as gasoline or free-flowing (medical oxygen).
- Do not use a cell phone or HF radio within 1.2m of an AED. This can interrupt the analysis.