Patients internal defib keeps on shocking the pt

[Dustdevil]

I have to admit that I have never encountered this in the field. Or in the hospital either, for that matter.

(Not too many kids running around with implanted defibrillators, I suppose. )

But can others who have seen it tell me if Nate's experience is typical? Are the patients almost always reasonably comfortable? Or are there going to be some who might need a little Valium?

[ERDoc]

I have to admit that I have never encountered this in the field. Or in the hospital either, for that matter.

(Not too many kids running around with implanted defibrillators, I suppose. )

But can others who have seen it tell me if Nate's experience is typical? Are the patients almost always reasonably comfortable? Or are there going to be some who might need a little Valium?

This is one of those situations where it depends on your pt. Those with a low pain tolerance will be screaming like they have a 2 foot kidney stone, while others will just describe it as annoying. Personally, I'm a big fan of aerial spraying of valium, percocet, diaudid and zocor.

[TechMedic05]

Mmmmm Aerosolized Valium... What a great idea. Oh, for patients, too.

Anyways, I can't say that this happened to me, but while riding for Medic, my preceptor told me about an interesting case he had a few nights prior on one shift:

Nursing home calls for multiple AICD firings of a patient. Something to the tune of twelve. Then the AICD stopped functioning. ALS work up finds pt. in V-Tach at 180, cardioverted x2 or 3, Amiodarone without conversion. Then, after about 10 minutes, the AICD became operational again, and continued to shock.

Now, Kinda off topic, but will they do that? I can't imagine their batteries are all that powerful, will the capacitor draw enough energy to make the device need a 'rest' per se?

Sorry, not trying to hijack.

[Punisher]

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

Yet another obviously well thought out recommendation from our staff cardiologist :roll: As someone else said, unless you have ALS capability- EKG, pacing, cardioversion- do NOT use a magnet. Even if it doesn't kill the patient (assuming you were stupid enough to override the AICD without checking the rhythm first- which is something I wouldn't put past certain individuals on this site who shall remain nameless), trust me they will not be happy with you if you swap out a 10-20 joule internal shock for a 100-200 joule external cardioversion.

[chbare]

Good thread, I agree with you ERDoc. I have seen some people who say if feels like a numb pins and needles sensation, while others howl in pain.

We had a cardiologist who would wheel in his little machine and put an external device directly on the Chest wall above the AICD. It was pretty neat to see, he could call up the devices history and even change the device settings. All of the nurses hated this doc because he was rude and arrogant, but he provided top notch care and he was excellent with his patients. The first transvenous pacemaker placement that I saw was performed by his hands. I grew to really like him, sure we threw some french duologue at one and other, but he was a top notch doc and would take the time to teach and explain things if you asked. Too bad he moved. I hear he is in ERDocs neck of the woods.

TechMedic05, I imagine life span is pretty variable, but i have been told that most pacemaker type devices have a general life of 5-10 years. Here is a good article about pacemakers and AICD's.

http://www.emedicine.com/emerg/topic805.htm

Take care,

chbare.

[PRPGfirerescuetech]

Yet another obviously well thought out recommendation from our staff cardiologist :roll: As someone else said, unless you have ALS capability- EKG, pacing, cardioversion- do NOT use a magnet. Even if it doesn't kill the patient (assuming you were stupid enough to override the AICD without checking the rhythm first- which is something I wouldn't put past certain individuals on this site who shall remain nameless), trust me they will not be happy with you if you swap out a 10-20 joule internal shock for a 100-200 joule external cardioversion.

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

If protocols allow it. This obviously considers several parts to be included in the decision to stop a pacer. One, the ability to interpret a already acquired ECG, the meds and manual defbrillator capability to pace, and intubation.

This was a suggestion based around the ability to do it.

and yes, there ARE counties here doing it. As well as counties elsewhere.

XoXo

PRPG

[Janmarie3]

Would to much potassium cause an internal defib to continually shock? An old guy here had that happen to him.

[Ridryder 911]

Would to much potassium cause an internal defib to continually shock? An old guy here had that happen to him.

Electrolyte (not just isolated to K+, but Na+, Ca+ etc..) imbalances can cause life threatening arrhythmias which then the AICD would defibrillate.

R/r 911

[mediccjh]

Ok reject, maybe you didnt read me right.

If protocols allow it. This obviously considers several parts to be included in the decision to stop a pacer. One, the ability to interpret a already acquired ECG, the meds and manual defbrillator capability to pace, and intubation.

This was a suggestion based around the ability to do it.

and yes, there ARE counties here doing it. As well as counties elsewhere.

XoXo

PRPG

I think you are just being sarcastic about the magnet. But they deserve the magnet if they're getting on your nerves.

[Punisher]

Does that mean we can use the magnet on other EMS personnel?