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Patient with pacemaker primary healthcare treatment

Discussion in 'Medical Students - MD' started by SDonlagic, Aug 13, 2011.

  1. SDonlagic

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    This is the question I've got from professor on exam.She asked me ,what wolud I do if I get a patient with a pacemaker and a heart decompensation in "urgent unit" (that is what is called here in Bosnia,I guess Ambulance) . Please ,if someone has idea , help !
     
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  3. armybound

    armybound urologist.
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  4. Marcus Brody

    Marcus Brody Already has the grail.
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    Call the manufacturer so they can interrogate it. :shrug:
     
  5. OveractiveBrain

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    Ok, bub, vocabulary is getting in the way.

    "Heart Decompensation" means "CHF exacerbation" or "is in shock, ****ting the bed, about to die?"

    "Urgent Unit" is the "Ambulance"

    Either way, it doesn't matter. The bottom line is that you ignore it. In the ambulance, you cant reach in and turn up the pacer (assuming the AICD) has one. You can't tell it to fire. But what you can do is transcutaneous pacing or cardioversion (defibrillation or syncrhonous cardioversion).

    But what if you're in the hospital? If the patient is in cardiogenic shock, or pulmonary edema, or whatever. You are going to through on pressors of some sort, treat the pulmonary edema, etc. The fact that there is an AICD again doesn't matter.

    Where it does matter is when cardiology comes in and says "oh, the battery is broken, his pacer won't fire and if he goes into vifb, it won't shock, lets schedule him to have it changed tomorrow!" or "man, he's pretty bradycardic, maybe I should turn up his rate" <doot doot doo-doot> "there you go, pacer fixed, patient fixed. I AM A GOD!"

    Am I getting close?
     
    #4 OveractiveBrain, Aug 14, 2011
    Last edited: Aug 15, 2011
  6. SDonlagic

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    Decompensation= assuming a patient had chronic heart failure which was compensated with pacemaker, after pacemaker malfunction ,his heart is unable to "pump blood properly"= Heart failure. It could be any degree, life thretening or not... in this case , patient had pulmonary edema.

    If i got it right ,every condition should be treated like there is no pacemaker at all. In this case,should treat him with oxigen, morfin, furosemid,dioxine...of course ,unless there are contraindications. Is that it ?
    Thanks , and nice beard :)
    P.S.
    sorry for terminology and my English..
     
  7. Get an EKG. If the pacemaker's battery is dead, get transcutaneous pacing pads and get him to an ambulance to have the pacer fixed.

    If the pacer is working fine, you can go more the medical management route.
     
  8. jdh71

    jdh71 epiphany at nine thousand six hundred feet
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    If he's pacer dependent you'll need to pace him yourself

    Other than that you treat what needs treating
     
  9. SDonlagic

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    Is it possible that broken pacemaker fires abnormallly (abnormal freq. or waves,etc) ? Does anyone have expirience with such case? Has anyone met this in literature?
     
    #8 SDonlagic, Aug 16, 2011
    Last edited: Aug 16, 2011

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