What does anterolateral placement mean?

Anterolateral Placement in Defibrillation and Medical Procedures

Anterolateral placement refers to a standard electrode pad position for defibrillation where one pad is placed below the right clavicle (just to the right of the upper sternal border) and the other pad is placed in the left midaxillary line, effectively encompassing the heart between the two pads.

Defibrillation Pad Placement

Anterolateral Placement in Cardiac Resuscitation

Anterolateral pad placement is considered the default position for defibrillation due to several advantages:

• It is recommended as a reasonable default electrode placement (Class IIa, LOE C) by the American Heart Association 1
• It provides effective shock delivery by positioning the heart between the two electrodes
• It offers ease of placement and simplicity for education purposes 1
• It allows for consistent pad placement during emergency situations

The anterolateral position involves:

• First pad: Below the right clavicle, just to the right of the upper sternal border
• Second pad: Left midaxillary line with the center of the pad positioned laterally

Effectiveness Compared to Other Positions

According to the 2010 AHA guidelines, four pad positions have been studied for defibrillation:

1. Anterolateral (standard default position)
2. Anteroposterior
3. Anterior-left infrascapular
4. Anterior-right infrascapular

All four positions are equally effective in shock success (Class IIa, LOE B) 1, but anterolateral is preferred for its simplicity and accessibility.

Special Considerations for Pad Placement

For patients with implanted devices (pacemakers or ICDs):

• Anterolateral placement is acceptable 1
• Pads should be positioned at least 8 cm away from the device 1
• Avoid placing pads directly over the implanted device (Class IIb, LOE C) 1

For patients with large breasts:

• Place the left electrode pad lateral to or underneath the left breast, avoiding breast tissue 1
• Ensure good skin contact for effective current delivery

Anterolateral Approaches in Other Medical Contexts

While the term "anterolateral" is most commonly associated with defibrillation pad placement in emergency cardiac care, it also has applications in other medical fields:

1. In cardiac resynchronization therapy: The anterolateral vein is one of the possible venous tributaries of the coronary sinus where a left ventricular lead can be positioned 1

2. In orthopedic surgery: The anterolateral approach refers to an intermuscular plane between the tensor fascia lata and gluteus medius muscles used for hip surgery 2

3. In neurosurgery: An anterolateral approach can be used for accessing the cervical spinal canal 3

Technical Considerations for Defibrillation

For optimal defibrillation effectiveness:

• Ensure pads are properly sized (8-12 cm diameter is recommended) 1
• Remove excessive chest hair if it would impede good contact 1
• Ensure the skin is dry before pad application 1
• Remove any medication patches from the area where pads will be placed 1

Common Pitfalls to Avoid

• Incorrect pad placement: Failing to position pads to encompass the heart between them
• Poor skin contact: Not ensuring full contact between the pad and skin
• Placing pads over implanted devices: Can damage the device or reduce defibrillation effectiveness
• Placing pads over medication patches: Can cause skin burns and reduce energy delivery
• Using pads that are too small: May result in higher transthoracic impedance and reduced effectiveness

By understanding and implementing proper anterolateral placement for defibrillation, healthcare providers can optimize the effectiveness of this life-saving intervention while minimizing potential complications.