Defibrillation pads are being applied to an adult with an implanted permanent pacemaker in the right infraclavicular region who develops ventricular fibrillation. The correct action regarding pad placement is:
- A Place the anterolateral pads directly over the device to maximise current delivery
- B Remove the pacemaker generator before delivering any shock
- C Avoid placing a pad directly over the device, keeping it at least 8 cm away ✓
- D Pads cannot be safely applied and transcutaneous pacing must be used instead
Correct answer: C. Avoid placing a pad directly over the device, keeping it at least 8 cm away
Explanation
Pads should be positioned in the standard anterolateral location but not directly over the pulse generator, keeping roughly 8 cm clearance, because current delivered across the device can damage it and impair function. Device interrogation after successful resuscitation is advised. Generator removal during an arrest is impractical and unnecessary, and there is no contraindication to using a manual defibrillator or AED simply because a device is present.
Reference: AHA Guidelines for CPR and Emergency Cardiovascular Care, 2020 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.