defibrillators

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l14capri

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ok, i don't know how many out there know this and i don't, but what pre-hospital treatment can you give a pt who's defib keeps going off besides cp and acls protocol? thanks for all the help:)
 
Generally speaking cardioversion and anti arrythmatics
 
Treatment depends on why the defib is going off. Generally though an anti-dysrhythmic is what is administered, like lidocaine, or amiodorone.

I would be careful with chest pain protocol. Are they having chest pain because of an underlying cardiac event? Or does their chest hurt because they've been zapped? I've heard patients describe it as being kicked in the chest by a horse, and if their chest is hurting from being zapped, nitro isn't going to do anything for them.
 
He said "besides ACLS" though... which essentially all that's left is transporting to the ED.
 
My understanding is that some systems are stocked with a ring magnet and a specific protocol to disarm erroneously firing internal cardiac defibrilators. Please note the use of the term "erroneously" because my understanding also is that an ICD is much less painful than external cardioversion/defibrillation.
 
JPINFV said:
My understanding is that some systems are stocked with a ring magnet and a specific protocol to disarm erroneously firing internal cardiac defibrilators. Please note the use of the term "erroneously" because my understanding also is that an ICD is much less painful than external cardioversion/defibrillation.
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usually the magnet is to disarm a malfunctioning pacemaker and after sedate and administer TCP.

I have had a handful of patients that had multiple or constant discharging of implanted defibrilators. I chose to support them and deliver them to cardiology or C/T surg. Let them clean up that mess.

A more interesting case I once had was a 80+ y/o in Vtach (with a pulse) neither hypotensive nor altered in LOC and an implanted pacemaker that failed. I was surprised to receive orders from med control (I was new once too) to initiate TCP. I altered him with the versed but his other vitals didn't change much. Probably safer to be paced then left in VT though.

I thought it was interesting because "initiate TCP" is not a frequent phrase when talking about VT.

My black cloud follows me everywhere and randomly throws lightning bolts, I have become very good at getting out of unusual situations. :)
 
Veneficus said:
A more interesting case I once had was a 80+ y/o in Vtach (with a pulse) neither hypotensive nor altered in LOC and an implanted pacemaker that failed. I was surprised to receive orders from med control (I was new once too) to initiate TCP. I altered him with the versed but his other vitals didn't change much. Probably safer to be paced then left in VT though.
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Hmm ..... I'd have probably hung up some amiodarone

Veneficus said:
My black cloud follows me everywhere and randomly throws lightning bolts, I have become very good at getting out of unusual situations. :)
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Shouldn't talk about Mrs Veneficus like that .... :D
 
Linuss said:
He said "besides ACLS" though... which essentially all that's left is transporting to the ED.
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Irrelevant, since ACLS doesn't have a protocol for what they think you should do when a pt's ICD is going off.

Vene - I had a pt like that on my last day as an intern. Called for "seizure". Get there, the guy's complaint was that his left arm had been twitching on and off for 3 days. Hx of mild emphysema, on Advair and albuterol. Vitals were perfectly fine, aside from an irregular pulse. I'm thinking new onset A-fib. BZZZZZT! Wrong. Monomorphic V-Tach. We ended up converting the guy in an out of it 5-6 times with vagal maneuvers. We used vagal maneuvers because when we called med control they refused to give us orders for anything because they didn't believe us. <_<

It was a resident and thinking back on it, it was July.....
 
Aidey said:
It was a resident and thinking back on it, it was July.....
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Don't ever go to a teaching hospital in July. June? Yes. July? Transfer my butt.
 
Don't generalize as to what is in people's protocols.

Someone showed us the (city in Texas deleted) protocol for giving bicarb via neb for chlorine inhalation, which is worthless.
 
You can use a ring magnent to disable pacemakers/ICD's. They are made specifically for this purpose. Some protocols allow disabling implanted defibrillators.
 
mycrofft said:
Don't generalize as to what is in people's protocols.Someone showed us the (city in Texas deleted) protocol for giving bicarb via neb for chlorine inhalation, which is worthless.
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However, at the same time it's important to include the protocol issue if it a procedure requires a specialized piece of equipment not used in other interventions.
 
JPINFV, not my point, but yours is spot on too.

Quote:
"Irrelevant, since ACLS doesn't have a protocol for what they think you should do when a pt's ICD is going off".

My point is a metacommunicational one; some ACLS protocols do different things in different ways than others' do. Generalizations are error-prone.
 
I was referring to the AHA ACLS class and what it covers specifically, not protocols that fall under an organization's "ACLS" section. I wouldn't be surprised if agencies had protocols concerning ICDs, it just isn't something ACLS covers. Does that make sense?

Basically, I was nitpicking the semantics.
 
Aidey said:
Vene - I had a pt like that on my last day as an intern. Called for "seizure". Get there, the guy's complaint was that his left arm had been twitching on and off for 3 days. Hx of mild emphysema, on Advair and albuterol. Vitals were perfectly fine, aside from an irregular pulse. I'm thinking new onset A-fib. BZZZZZT! Wrong. Monomorphic V-Tach. We ended up converting the guy in an out of it 5-6 times with vagal maneuvers. We used vagal maneuvers because when we called med control they refused to give us orders for anything because they didn't believe us. <_<
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So you wanted to do what to a bloke with a stable arrhythmia in the back of an ambo?
 
Amiodarone.
 
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