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Advanced Cardiac Life Support (ACLS) Certification Course

Key To Using An Automated External Defibrillator (AED)

If you look around the public places you visit, you are likely to find an Automated External Defibrillator (AED). An AED is both sophisticated and easy to use, providing life-saving power in a user-friendly device which makes it useful for people who have never operated one and for anyone in stressful scenarios. However, the proper use of an AED is very important.

Ideally, while CPR is continued, turn on the AED, and then attach the pads to the upper right side and lower left side of the individual’s chest (Figure 11). Once the pads are attached correctly, the device will read the heart rhythm. If the pads are not attached appropriately, the device will indicate so with prompts. Once the rhythm is analyzed, the device will direct you to shock the individual if a shock is indicated.


Figure 11

A shock depolarizes all heart muscle cells at once, attempting to organize its electrical activity. In other words, the shock is intended to reset the heart’s abnormal electrical activity into a normal rhythm.

AED Key Points

Assure oxygen is NOT flowing across the patient’s chest when delivering shock

Do NOT stop chest compressions for more than 10 seconds when assessing the rhythm

Stay clear of patient when delivering shock

Assess pulse after the first two minutes of CPR

If the end-tidal CO2 is less than 10 mmHg during CPR, consider adding a vasopressor and improve chest compressions. However, after 20 minutes of CPR for an intubated individual, you may consider stopping resuscitation attempts.

Figure 12

Criteria to Apply AED

You should use an AED if:

  • The individual does not respond to shouting or shaking their shoulders.
  • The individual is not breathing or breathing ineffectively.
  • The carotid artery pulse cannot be detected.

Basic AED Operation

To use an AED, do the following:

  1. Power on the AED.
  2. Choose adult or pediatric pads.
  3. Attach the pads to bare chest (not over medication patches) and make sure cables are connected. (Dry the chest if necessary.)
  4. Place one pad on upper right side and the other on the chest a few inches below the left armpit.
  5. Clear the area to allow AED to read rhythm, which may take up to 15 seconds.
  6. If the AED states “no shock advised”, restart CPR.
  7. If the AED indicates a shock is needed, clear the individual, making sure no one is touching them and that the oxygen has been removed. Ensure visually that the individual is clear and shout “CLEAR!”
  8. Press the “Shock” button.
  9. Immediately resume CPR starting with chest compressions.
  10. After two minutes of CPR, the AED with current programming will analyze the rhythm.
  11. Continue to follow the AED prompts.
Take Note
  • If the AED is not working properly, continue CPR. Do not waste excessive time troubleshooting the AED. CPR always comes first, and AEDs are supplemental.
  • Do not use the AED in water.
  • AED is not contraindicated in individuals with implanted defibrillator/pacemaker; however, do not place pad directly over the device.