pacemakers

[zzyzx]

If a patient has an implanted pacemaker, will you always be able to see it under the skin of their chest, or are the newer models small enough to not be easily visible?

[1EMT-P]

Most of the pacers that I have seen have been implanted in the left upper chest, but I have seen a few that were implanted in the abdomen & the right upper chest. Most pacer patient's usually have a small scar & sometimes you can feel & see an outline of the pacer.

[Code 8 Paramedic]

alot of the time you can see them... but there are some that are hard to find, or not visable... but you should be able to see it with your ECG.. sometimes you have to turn on the interal pacer detector

[emt322632]

It also depends on the patient as to whether or not you can actually see the outline of the pacemaker...if the patient is relatively large you may have a hard time seeing it in my experience...

[crazycanuck]

Most new pacemakers and ICDs are getting very discreet. The current models are just 1.5-2 inches square and < 1/4" thick. Many times, they are implanted in a pocket subdurally, however it is becoming increasingly popular, especially in younger people to implant them subpectorally for extra protection and cosmetic purposes. It is also possible to have them implanted not only as aforementioned abdominally or right-sided, but also rather than directly under the clavicle to have them placed more laterally toward the midaxillary line, or even within the breast tissue in females. Incisions as well are becoming much smaller and unless you look specifically, you may overlook some of the more discreet insertions.

Unless I point it out, nobody would find my device. Often you can feel a ridge on the lateral edge where the interface of the leads connects with the battery/processor unit, but again it is not usually a glaring finding.

Also most current models are demand pacers, and often times may have a low pace rate of 50bpm. If your patient is in NSR and their intrinsic rate is capable of exceeding 50bpm, they will not be paced and therefore only the sensing by the internal leads is detected. Unless you have a new model of monitor capable of direct telemetry you may have no idea unless they are being overtly paced. That being said, hopefully in most cases your patient will have informed you or you will have access to PMH or their implant ID.

Hope this helps,

crazycanuck

[tniuqs]

Hope this helps,crazycanuck

YOU said inches.....te he he!

[crazycanuck]

YOU said inches.....te he he!

My dear squint, I normally am a definite metric person, however sometimes I choose to just go with the flow :wink:

___

CC

lover of the metric system since 1963