Modifying paddles placement - Dextrocardia

[celticcare]

Ok, just been thinking lately, and how there is the main placement of paddles for defibrillation of sternum and apex for your general defibrillation and cardioversion etc, what do you do if you have a patient with Dextrocardia (Heart facing the right hand side)?

Do we still go for the paddles in their usual spots.... and hope we get a shock through.... or do we modify the placement of the paddles. I have been talking to my cardiac nurse educator and she was saying it is something that medic alert makes a bracelet for so if we came across it, do we need to modify paddle placement, hand position for CPR or go with what we know and hope it works?

I know it is rare and probably has never been encountered, but am just curious what would you do if you were presented with a cardiac arrest on a patient who'se medic alert tag said they had Dextrocardia.

Thanks and here is an xray image of Dextrocardia to reinforce the topic...

Scotty

[reaper]

Ok, just been thinking lately, and how there is the main placement of paddles for defibrillation of sternum and apex for your general defibrillation and cardioversion etc, what do you do if you have a patient with Dextrocardia (Heart facing the right hand side)?

Do we still go for the paddles in their usual spots.... and hope we get a shock through.... or do we modify the placement of the paddles. I have been talking to my cardiac nurse educator and she was saying it is something that medic alert makes a bracelet for so if we came across it, do we need to modify paddle placement, hand position for CPR or go with what we know and hope it works?

I know it is rare and probably has never been encountered, but am just curious what would you do if you were presented with a cardiac arrest on a patient who'se medic alert tag said they had Dextrocardia.

Thanks and here is an xray image of Dextrocardia to reinforce the topic...

Scotty

I would think that hand placement would remain the same. Reversing the pad placement would be better, to ensure the electrical pathway remained the same. This is something you would need to bring up o a cardiologist!

[rock_shoes]

I would be inclined to mirror normal placement in this case. Unless the patient had a medical alert of some kind (as was mentioned in a previous post) it's highly unlikely you would know anyways. A cardiologist would be able to give you the best answer of course.

[Ensihoitaja]

This case study shows that it may not be necessary to alter your pad placement.

[celticcare]

Hey thats awesome, its something that I've been thinking about just curious really, I'll talk to one of the docs at work when I'm next back on shift.