During defibrillation in pediatric CPR, which practice should be avoided to maintain safety?

• A. Do not place pads over implanted devices if present
• B. Place pads directly over implanted devices if present
• C. Always place pads on back
• D. Avoid defibrillation entirely if implanted device present

Answer: (A)

The safety issue here is avoiding damage or malfunction of implanted cardiac devices during defibrillation. Defibrillation energy can flow into or through a pacemaker or ICD if a pad sits directly on the device, which can damage the device, cause heating, or lead to inappropriate sensing or pacing issues. So the best practice is to place the defibrillation pads away from the implanted device, while still aiming energy through the heart—common approaches are anterior-lateral or anteroposterior placements that bypass the device location.

If pads are kept away from the device, you reduce the risk of damaging the device and improve the chances that the shock properly defibrillates the heart. The other options imply either placing pads directly over the device, which is unsafe; insisting on back-only placement, which isn’t a universal requirement and isn’t always optimal for energy delivery; or avoiding defibrillation altogether, which isn’t appropriate when a shock is indicated.