Switching to hospital pacer after transport

[snatchgripRDL]

What is the process to change over to the hospital pacer following transport? Scenairo - in the field, find a patient in symptomatic brady, no response to medications, initiate pacing with good electrical and mechanical capture using the Lifepak 12. You arrive at hospital and the ER wants to continue to pace the patient. The ER also has the Lifepak 12, how do you switch Lifepaks and pads without losing capture?

[mobey]

This is one of the best questions I have seen posted here in ages.

I always end up trading the ER LP's until we get back, but that is the nice part of working remote EMS, we always return to the same community, and have trust between agancies.

[scubanurse]

Great question! I would imagine the ER can place their pacer pads on and gain capture at the same time you have capture and then you can remove your pads? Or they should have the ability to switch the pads over and then re-gain capture?

[Arctickat]

It's not something I've ever encountered and likely never would. If we're pacing someone here they'd go straight to a distant CCU after stopping at our local hospital. Once we arrive in the CCU they have a completely different setup and therefore we have to d/c pacing and they put theirs on.

[Curiosity]

I've seen them call in cardiology and have a trans venous pacer put in place before DCing external pacing.

[mobey]

It's not something I've ever encountered and likely never would. If we're pacing someone here they'd go straight to a distant CCU after stopping at our local hospital. Once we arrive in the CCU they have a completely different setup and therefore we have to d/c pacing and they put theirs on.

What do you do in the event that you are called to do a transfer of a patient whom is already being paced by your hospital? (Also... anyone know why my "return" key won't work on the city?? Not windows 8 compatable?) Edited December 19, 2012 by mobey

[Arctickat]

Gotta switch them, We use LP12, they use whatever had the lowest quote that week they purchased it. However, we've never had that situation because the hospital knows the paced patient is going to the city and they call us to put ours on if we aren't already there, unless the patient is too unstable to wait 5 minutes for us, in which case we'd have to do full swap.

I've tried to suggest that we just take theirs and we leave ours, but it's too complex for them and they don't wanna learn how to use it.

Edited December 19, 2012 by Arctickat

[ChaseZ]

I've seen them call in cardiology and have a trans venous pacer put in place before DCing external pacing.

Depends on the facility but most will just start a transvenous pacer in they truly need to be paced.

[spenac]

Often the hospital wants to see what happens when pacing is removed. Perhaps problem corrected itself. Perhaps the meds you pushed started working late. Perhaps you were wrong. Lets the doctor see just what is going on. Much like O2. Our hospitals like the idea of us removing O2 if patient is not struggling to breath in order to see how much they desat in the couple of minutes from the ambulance to the ER room. Difference is we leave pacing on while they prep for pacing so patient only has short time of going back low pulse if they go back low pulse. Surprising how many seem to maintain a good rate once they have been paced for a half hour. Now there are others that go quickly to a lower rate than they were when we started after we disconnect.

[Tom B.]

What is the process to change over to the hospital pacer following transport? Scenairo - in the field, find a patient in symptomatic brady, no response to medications, initiate pacing with good electrical and mechanical capture using the Lifepak 12. You arrive at hospital and the ER wants to continue to pace the patient. The ER also has the Lifepak 12, how do you switch Lifepaks and pads without losing capture?

Do you have the strips by any chance? It's so rare to see true electical capture achieved in the field I'm sure we'd all learn a lot from the case. In my experience the ED physician wants to see the underlying rhythm anyway. I remember on one occasion the pacer was turned off and there was (almost) nothing underneath. They turned it right back on and took the patient up to the cath lab with our LP12 attached. Not sure what happened when they got there but one of the nurses brought back our machine.