Out Of Settings Internal Defib

[uglyEMT]

Hey folks, figured I would bring this out to the masses to both bring light to the topic but also ask for advise for the future.

Had a patient with a recently installed internal defib unit that was going berserk. I mean this thing was tasing this poor person. From 8 feet away you could hear the "snap" of the electronic stimulation.

Every time the patient moved it would do this. Took me a minute to figure out a position of comfort that didn't shock her, kept my crew safe, and were able to move the patient to the rig. Settled on the stair chair and it worked.

Once in the rig we took vitals and within a few minutes met ALS in route. Once they had the 12 lead on they said she was in continuous Afib. Vitals went from extremely high to bottoming out. Medics did there thing as far as patient comfort, blood work, ect. We transported w/o incident and transfered care.

What I want to know is there anything outside the prehospital setting we can do other then what was stated? The defib was only 4 days old if that helps. Is this just a load and go, liberal diesl bolous, monitor patient kind of thing or is there something that could be done to correct, at least temporarily, outside a hospital?

[Just Plain Ruff]

i'm a firm believer of having a magnet that is in each ambulance in order to help the patient.

I don't say this lightly but I do recommend that before every ambulance service gets a magnet (looks like a doughnut) that you get training from a cardiologist who puts these devices in.

You should also have a medical control group that approves of the magnets.

I have had a number of patients with this happen to them. about 12 or so over 20 years. It hurts like hell for the patient and I feel very bad for them.

It's pretty simple, just place the magnet directly over the bulge where the implanted defib is.

Need to get online medical control involved in this procedure so they know what they are getting ready to receive.

if you don't get the training from someone competent in this as well as no buy in by your medical control then don't do it.

but of the 12 I've taken care of, the three that we used the magnet on thanked us for making it stop.

[systemet]

i'm a firm believer of having a magnet that is in each ambulance in order to help the patient.

.....

but of the 12 I've taken care of, the three that we used the magnet on thanked us for making it stop.

12? Wow.

I would add to be very very sure that the AICD/pacemaker is functioning inappropriately before you do this. I have had patients complain "my pacemaker's broken, it keeps shocking me!", who were being defibrillated / cardioverted out of VF / VT.

[Just Plain Ruff]

12? Wow.

I would add to be very very sure that the AICD/pacemaker is functioning inappropriately before you do this. I have had patients complain "my pacemaker's broken, it keeps shocking me!", who were being defibrillated / cardioverted out of VF / VT.

Oh goodness yes. You have to make sure that the AICD is not functioning right. I never just placed it on willy nilly.

There was a line of AICD's that apparantly had malfunctioning connectors or something like that. some of our patients needed replacement AICD's.

The only way I would put one of those magnets on is if I had a documented strip of the defib firing on a perfectly good non-shockable rhythem. Had one guy with a normal sinus rhythm getting shocked every 45 seconds.

I'll run the strip through at least 3 if not 4 shocks and if rhythm is the same, I'll put the magnet on but not without medical control OK. I have to have med control approval to do this.

I will also put the external defib patches on just in case the patient does get a shockable rhythm and the magnets on. Every one of the times I've put the magnet on, the patient did fine.

But I'm going to make sure that I have a good rhythm prior to putting it on. I hope that I didn't sound Like I'd put it on immediately because that would be a stupid decision.

[systemet]

But I'm going to make sure that I have a good rhythm prior to putting it on. I hope that I didn't sound Like I'd put it on immediately because that would be a stupid decision.

No, you didn't. I just wanted to make sure that no-one reading this misunderstood.

[uglyEMT]

Thanks for the heads up Ruff. Might be above my pay grade LOL being I we don't carry 12 leads it might be a more ALS thing in my area, but will pass it up the food chain. Might be able to carry it just not use it. Like our Saline chiller warmer. We can carry and swap out as necessary the Saline IV bags, tubes, ect but are strictly forbidden to use them without ALS on board. Wierd I know but hey thats what the MC wants.

Yes this patient had 7 "shocks" that I witnessed all the while showing Afib (medics words not my interpritation). Even the attending at the ED, who knew the patient from discharge, agreed this was a "settings" issue. I have had experience with a pace maker this was my first internal defib unit so I just wanted to comfirm things. Hell I was even nervous at first about touching her, you know that whole "clear" thing during external defib, a quick call to MC confirmed no risk to us so it made transfer from initial position to stair chair to rig. One thing I don't think I will forget is the sound, I didn't think it would have been audiable.

Hopefully others respond as well and keep this moving foward for all of us to learn.

[Just Plain Ruff]

Thanks for the heads up Ruff. Might be above my pay grade LOL being I we don't carry 12 leads it might be a more ALS thing in my area, but will pass it up the food chain. Might be able to carry it just not use it. Like our Saline chiller warmer. We can carry and swap out as necessary the Saline IV bags, tubes, ect but are strictly forbidden to use them without ALS on board. Wierd I know but hey thats what the MC wants.

Yes this patient had 7 "shocks" that I witnessed all the while showing Afib (medics words not my interpritation). Even the attending at the ED, who knew the patient from discharge, agreed this was a "settings" issue. I have had experience with a pace maker this was my first internal defib unit so I just wanted to comfirm things. Hell I was even nervous at first about touching her, you know that whole "clear" thing during external defib, a quick call to MC confirmed no risk to us so it made transfer from initial position to stair chair to rig. One thing I don't think I will forget is the sound, I didn't think it would have been audiable.

Hopefully others respond as well and keep this moving foward for all of us to learn.

honestly, you don't even need a 12 lead for this. Just verification through a couple of shocks that the rhythm was one that should not be shocked.

for the last patient we had, we just loaded him up in the ambulance after putting the magnet on him and drove him 80 miles to the cardiac facility that put it in. I mean there wasn't anything else wrong with him other than a loose wire that was shorting the device. They took him to the OR or wherever they put that thing in, replaced the device and the wires, and sent him home after a day or two. I don't even remember how long he was in the hospital for. Never got another call on him.

the magnet should never be used/nor considered to be used by a EMS system without a cardiac monitor, ergo BLS system.

[ERDoc]

I will also put the external defib patches on just in case the patient does get a shockable rhythm and the magnets on. Every one of the times I've put the magnet on, the patient did fine.

Don't do this. If the pt goes into a shockable rhythm, just take the magnet off and the AICD will run through it's cycle. If you notice the pt converts and the device is still firing, put the magnet back on.

[crotchitymedic1986]

You could have chose to treat the Afib with medicine (I am guessing the heart rate was high, causing a low b/p). I would also recommend switching leads to make sure you are not missing the pacemaker spikes, that sometimes are not visible in just one lead (yes it happens), it would be bad to shut off the pacemaker if the patient is 100% paced.

[ERDoc]

You could have chose to treat the Afib with medicine (I am guessing the heart rate was high, causing a low b/p). I would also recommend switching leads to make sure you are not missing the pacemaker spikes, that sometimes are not visible in just one lead (yes it happens), it would be bad to shut off the pacemaker if the patient is 100% paced.

You obviously have no idea how AICDs work. You might want to read up before you kill someone or cause them unnecessary pain.