Patients internal defib keeps on shocking the pt

[ghurty]

Hi,

A call went out to my squad the other day, I didnt repsond to it, but what should i do in shuch a case:

A patient with an internal defib keeps on shocking.

I think that I request medics, transport and keep my eye open incase I need to begin CPR.

Am I right? and if yes, what else should I do.

Thankx

[PRPGfirerescuetech]

Lotsa oxygen, and hit em with a magnet if your protocols allow it.

[Asysin2leads]

Well if feeling like getting charged wth negligent homicide, feel free to use a magnet. I'm not exactly sure about what a magnet will do to an internal defib, but it will rest a pacemaker, which if you don't have proper ALS equipment is basically like playing russian roulette with the patient, which they never find amusing.

The answer is get ALS there ASAP.

[JPINFV]

Well, if the internal defib keeps shocking I can think of two reasons why its doing it, both bad (the Pt either needs it, or its a malfunction).

In this case, use the EMT-B easy button. Phone a friend (i.e. either get a medic or get to a paramedic receiving center. What ever is closer).

[Arachne]

Hey, as long as it's not going to shock me, it seems easy enough to deal with: Put them on the stretcher, manage the airway/give them oxygen if they seem to need it, monitor vital signs and take them to the hospital. Extra points if you can intercept with ALS. Personally, I'd not want to delay transport waiting for medics*: If the patient needs it to go off that often, they're very sick and need to go now, and if it's malfunctioning, it could interrupt normal function and cause them to become very sick.

*Unless you're in very rural EMS and have the choice between doctor in an hour or medic in 15 minutes...where I work we can often get to the hospital before the medics can get to us, so we try to intercept and don't sweat it if they can't catch us.

[Dustdevil]

I think I'd use it as more evidence to take to my community leaders and demand that they provide a reasonable standard of care for the taxpayers. If they are failing to provide full-time professional ALS care to the community, both they and the citizens need to know it and address it.

That's the best thing you could do for your patients.

[ERDoc]

Unless you have monitoring capabilities I would not use a magnet. The pt needs to be put on a montior, but depending on your proximity to the hospital it might not be worth waiting for ALS. If the AICD is firing because the pt needs it, it is doing its job and doing it correctly if he is still conscious. You may want to have the AED out just in case, but let the AICD do it's job. If it's malfunctioning, there is not much any level of prehosital provider is going to do about it.

[akroeze]

Unless you have monitoring capabilities I would not use a magnet. The pt needs to be put on a montior, but depending on your proximity to the hospital it might not be worth waiting for ALS. If the AICD is firing because the pt needs it, it is doing its job and doing it correctly if he is still conscious. You may want to have the AED out just in case, but let the AICD do it's job. If it's malfunctioning, there is not much any level of prehosital provider is going to do about it.

So what would an ALS provider do?

Malfunction: Nothing more than an basic really right? I mean other than a precautionary line and EKG

Needed: Would you push drugs in this situation?

[ERDoc]

So what would an ALS provider do?

Malfunction: Nothing more than an basic really right? I mean other than a precautionary line and EKG

Needed: Would you push drugs in this situation?

No drugs, but in case the unit started to go south and the pt became unstable it might be good to have ALS. I would put on a monitor and definately get a line going.

[Nate]

Basically setup for the worst case, that's about all you can do.

I've had three patients with this problem, only two had bad units. The patients wasn't comfortable, but they weren't really in pain. I just put them on the monitor, asked what hospital their cardiologist was from. If it was reasonable, I would transport them to that hospital (if they were able to handle it).

If I was a BLS provider, I would just go to the local hospital and let them stabilize and treat, or transport out via helicopter or ALS transfer service.