Patients internal defib keeps on shocking the pt

[AZCEP]

In the absence of any other moderately heavy object to be forcibly applied to the side of the head, sure.

Also works well for those that have ferrous metal near their brain--read: cousin Eddie from the Vacation movies.

[ghurty]

Thank you for all the replys.

The way it works here in Monmouth, NJ. Is that the BLS squad are volunteer backed up by ALS (Monoc) out of the hospitals.

I did a follow up to find out what happend in this case, so far what I know is that the Internal defib., had shocked the PT 3 times before BLS got there, and once while BLS was there, they requested an ALS assist, the medics then transported the pt to the ER where the internal defib shocked once more. It turns out that the defib was malfunctioning, but I dont know yet exactly what happend in the ER in the way of treatment.

It was interesting that the medics transported, because usually when BLS is on scene and they request an ALS assist, a medic then rides in the BLS rig to the hospital. I guess maybe the medics had special non portable equipment in thier rig that they wanted to use.

[Punisher]

Ok (edited by PRPG to promote kumbyyah) maybe you didnt read me right.

Holy crap, I guess the "report" button actually works! Really it should be relabeled as the "Adjust Attitude" button....

Alternatively, the "Instill respect for those with more experience and education" button.

Also works well for those that have ferrous metal near their brain--read: cousin Eddie from the Vacation movies.

I don't know about having a metal plate in their heads but I know more than a few EMS providers (including a few of members of various online forums- a couple here at EMTCity, more than a few at EMTLife, and a few at the prehospital section of SDN, etc) that remind me of Eddie.

[Spock]

OK, I have some experience with AICD's. We put in several every week and have to sedate the patient for the testing. Every patient I have ever talked to say it feels like a horse kicking them in the chest when it goes off. People that say it is only uncomfortable are tough hombres.

Dispatch for an AICD firing should always be ALS. There are two reasons for it to fire: arrhythmia or malfunction with malfunctions rare. Put the patient on the EKG and see if it shocks sinus rhythm. If it does then the thing is malfunctioning. Treat with oxygen, IV access, versed and fentanyl for comfort. Transport immediately. Be prepared for an R on T and V-fib. If BLS can get to the hospital before ALS gets on scene then by all means go but remember that ALS should have been dispatched from the outset. If the pt is having arrhythmia's then treat with amiodarone and sedation if necessary.

We use a donut shaped magnet to disable the AICD in an emergency. Otherwise we have staff from the EP lab come down and interrogate the device. That is the wand chbare was talking about. They can determine the type of device and even battery life. They disarm the defib capability while leaving the pacer function operational. We then put the defib pads on and have the pt connected to a Zoll defib until whatever surgery they are having is complete and the pt is in the PACU. A bovie used to cauterize bleeding during surgery will set off the AICD unless it is turned off. All of the new AICD's for about the past five years (maybe longer) are defib and pacer combined. Put the magnet on the device and the defib is off and pacer function is operational (usually VVI). Remove the magnet and the AICD is operational. Some devices will give off an audible sound when the magnet is placed on it. Also remember most units have bipolar leads so the pacer spikes are very small. I don't think a paramedic should use a magnet in the ambulance unless he had orders to do so and also had the appropriate magnet. In any event, the device should only be shut off if malfunction is documented.

I don't know of any reason why the device should shut off for 10 minutes and then be operational again. Battery life is indeed 5-10 years depending on how many times it has to shock and pace. I've seen patients who have come in for battery changes after many years and they say it has never gone off.

Live long and prosper.

Spock

[buckeyedoc]

I've seen this once in the field and once in the ER. We were about 15 minutes from the ER with the patient. He is uncomfortable, but not in pain. He would cringe a bit when it would fire, but nothing serious. Ironically, his son was his cardiologist and was out of town at a convention and couldn't be reached. His daugher-in-law, also a cardiologist, was in town and beat us to the hospital. I never followed up, so I don't know how they corrected it. We had him on a monitor and a saline lock in place.

The one in the ER was coming in by squad as I was ending my shift so I wasn't around when they treated him and I never thought to ask about him. I know there was a cardiologist in the ER when I left. We had called him in for one of his patients who had come in, but I doubt it both patients were his.

[PRPGfirerescuetech]

Holy crap, I guess the "report" button actually works! Really it should be relabeled as the "Adjust Attitude" button....

Alternatively, the "Instill respect for those with more experience and education" button.

Respect is earned. You havent earned mine. At least, until I realized your "the Punisher formerly known as Ditch Doctor" and I recanted my prior statements. I still dont like you, but certainly respect you at the least.

[Ace844]

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.

Where did any one advise anyone to wait for medics? Even in Boston you can get ALS intercepts fairly easily if you and or the dispatcher are on the ball and know what your doing. Initiating a request for ALS intercept-assistance IS NOT SYNOMONOUS WITH WAITING ON A SCENE AND DELAYING THE PT ACESS TO CARE!! ALTHOUGH, admittedly the less educated and capable of our peers sometimes believe this. It is our job as experienced providers to re-educate, change, teach, cajole or step in where necessary. Just a quick note to self, and some food for thought...

Like the Texan comic Ron White says

," They can fix a lot of things these days with either surgery or a pill. But unfortunately for some. WE CAN'T YET FIX STUPID!"

Hope this helps,

ACE844

[Punisher]

Respect is earned. You havent earned mine. At least, until I realized your "the Punisher formerly known as Ditch Doctor" and I recanted my prior statements. I still dont like you, but certainly respect you at the least.

That's fair enough. I don't really like you much either, but only because I think you let your ego get in the way of your progression as a provider. Check it at the door and you have a lot of potential and will earn far more respect from those with more experience than yourself, myself included. That's my opinion, you can take it or leave it, but I don't imagine I am the only one who feels this way. By the way, I'm glad you respect me...honestly it means a lot to know I'm respected by my peers.

[PRPGfirerescuetech]

That's fair enough. I don't really like you much either, but only because I think you let your ego get in the way of your progression as a provider. Check it at the door and you have a lot of potential and will earn far more respect from those with more experience than yourself, myself included. That's my opinion, you can take it or leave it, but I don't imagine I am the only one who feels this way. By the way, I'm glad you respect me...honestly it means a lot to know I'm respected by my peers.

Thats fair as well.

I can only be me. My ego comes from the experience I have. I have learned over time when to check it at the door, and when not to. Ego and confidence goes hand in hand sometimes, and try to remember, one can be confused for another.

When people like Dust, Rid, yourself, and several others speak, I do take into account what you've said, and absorb and learn quite a bit from it. As do many others from this forum. This is the ideal purpose of a forum like this.

Remember Steve, knowledge can be overshadowed by attitude. Spend more time imparting knowledge and less time tearing people new backsides (in typical Ditch style) and you will be much better received.

In the mean time, Welcome back to EMTcity. I found the copies of the county protocols developed to include donut magnets to disable malfunctioning AICD's, and ill post them shortly.

PRPG

[Punisher]

I look forward to seeing your protocols.

I wasn't tearing you a new "anal cavity", just giving you a hard time. Trust me, I'm trying to be a kinder, gentler person. If there is anyone I was exceedingly brutal with over something on here during my previous tenure, I do apologize. There was a lot going on in my life that affected my attitude. Those issues have been taken care of now and I'm not going to tear into anyone unnecessarily.

BTW, ego and confidence are basically the same thing, just the former is an extreme (and often misguided) expression of the latter.