Pacemakers and FBAO

[skibum]

Hi all,

I had a rather heated discussion with an RN this morning, and want to run this by everyone here for their $.02. The RN claimed that when a PT has a pacemaker that the "Heimlich" (AKA abdominal thrusts), should not be used while conscious; but instead the PT should have a few good thumps on the back.

I have been an EMT for several years, and I have never heard of such a thing. Nor have I found any sort of confirmation of this online. And common sense (at least to me) would imply that this is pretty much B.S. and the RN is living up to my general expectations of a nurse.

Have any of you ever heard of any such thing? Is this perhaps an "ancient" protocol? Thoughts?

Thanks.

-skibum

[AZCEP]

It will depend on where the pacemaker is implanted. If it is located in the abdomen, then the standard abdominal thrust will risk damaging the underlying organs in the area.

Abdominal thrusts for the conscious FBAO patient are being de-emphasized anyway. For most, they are ineffective and unable to remove the obstruction.

[crazycanuck]

Hi Skibum,

I have never heard of this, though let's wait to see what everybody else has to say.

My suspicion is maybe this is her old school perception-- back in the day pacer and ICD pulse generators were large and implanted abdominally. Now this is not frequently the case, unless it's a ped patient who is too small for traditional implant or someone with erosion problems or other anatomical anomalies.

Perhaps back in the dark ages when we had much larger pulse generators implanted in the abdomen she was told not to perform abdominal thrusts due to risk of lead dislodgement. Even then, is she going to let someone choke so she doesn't "hurt their pacemaker"?!??!?!

Just my 0.02.

CC

[owley medic]

I agree with CC, In the big picture, "A" comes before Pacemaker...

Owley

[skibum]

Thanks for the input, just wanted to hear some other thoughts on this.

-skibum

[zzyzx]

AZCEP wrote: "Abdominal thrusts for the conscious FBAO patient are being de-emphasized anyway. For most, they are ineffective and unable to remove the obstruction." Could you elaborate? I haven't heard this before. I've never had do give abdominal thrust before, but I've heard many stories of them being effective.

[Ridryder 911]

AZCEP wrote: "Abdominal thrusts for the conscious FBAO patient are being de-emphasized anyway. For most, they are ineffective and unable to remove the obstruction." Could you elaborate? I haven't heard this before. I've never had do give abdominal thrust before, but I've heard many stories of them being effective.

I refer you to Emergency Cardiac Essentials and Guidelines from American Heart Association, with the revised 2005 AHA standards. Try Google and you should such articles being cited describing rationale and occurrences.

R/r 911

[zzyzx]

Ok, thanks Ridryder 911. I'll have to check into that.

[mediccjh]

Abdominal thrusts for the conscious FBAO patient are being de-emphasized anyway. For most, they are ineffective and unable to remove the obstruction.

I'm gonna disagree, because I did it, successfully one. My mother was choking on a piece of chicken, thrusted twice, and it shout out.

[CBEMT]

I'm gonna disagree, because I did it, successfully one. My mother was choking on a piece of chicken, thrusted twice, and it shout out.

That part hasn't been changed. My understanding was that the UNconscious FBAO abdominal thrusts (the ones on the floor rather than standing) were eliminated, which is whhat I hope AZ meant. Typo, I figured.