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Switching to hospital pacer after transport


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What is the process to change over to the hospital pacer following transport? Scenairo - in the field, find a patient in symptomatic brady, no response to medications, initiate pacing with good electrical and mechanical capture using the Lifepak 12. You arrive at hospital and the ER wants to continue to pace the patient. The ER also has the Lifepak 12, how do you switch Lifepaks and pads without losing capture?

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Posted · Report post

This is one of the best questions I have seen posted here in ages.

I always end up trading the ER LP's until we get back, but that is the nice part of working remote EMS, we always return to the same community, and have trust between agancies.

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Posted · Report post

Great question! I would imagine the ER can place their pacer pads on and gain capture at the same time you have capture and then you can remove your pads? Or they should have the ability to switch the pads over and then re-gain capture?

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It's not something I've ever encountered and likely never would. If we're pacing someone here they'd go straight to a distant CCU after stopping at our local hospital. Once we arrive in the CCU they have a completely different setup and therefore we have to d/c pacing and they put theirs on.

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I've seen them call in cardiology and have a trans venous pacer put in place before DCing external pacing.

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Posted (edited) · Report post

It's not something I've ever encountered and likely never would. If we're pacing someone here they'd go straight to a distant CCU after stopping at our local hospital. Once we arrive in the CCU they have a completely different setup and therefore we have to d/c pacing and they put theirs on.

What do you do in the event that you are called to do a transfer of a patient whom is already being paced by your hospital? (Also... anyone know why my "return" key won't work on the city?? Not windows 8 compatable?) Edited by mobey
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Posted (edited) · Report post

Gotta switch them, We use LP12, they use whatever had the lowest quote that week they purchased it. However, we've never had that situation because the hospital knows the paced patient is going to the city and they call us to put ours on if we aren't already there, unless the patient is too unstable to wait 5 minutes for us, in which case we'd have to do full swap.

I've tried to suggest that we just take theirs and we leave ours, but it's too complex for them and they don't wanna learn how to use it.

Edited by Arctickat
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Posted · Report post

I've seen them call in cardiology and have a trans venous pacer put in place before DCing external pacing.
Depends on the facility but most will just start a transvenous pacer in they truly need to be paced.
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Often the hospital wants to see what happens when pacing is removed. Perhaps problem corrected itself. Perhaps the meds you pushed started working late. Perhaps you were wrong. Lets the doctor see just what is going on. Much like O2. Our hospitals like the idea of us removing O2 if patient is not struggling to breath in order to see how much they desat in the couple of minutes from the ambulance to the ER room. Difference is we leave pacing on while they prep for pacing so patient only has short time of going back low pulse if they go back low pulse. Surprising how many seem to maintain a good rate once they have been paced for a half hour. Now there are others that go quickly to a lower rate than they were when we started after we disconnect.

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What is the process to change over to the hospital pacer following transport? Scenairo - in the field, find a patient in symptomatic brady, no response to medications, initiate pacing with good electrical and mechanical capture using the Lifepak 12. You arrive at hospital and the ER wants to continue to pace the patient. The ER also has the Lifepak 12, how do you switch Lifepaks and pads without losing capture?

Do you have the strips by any chance? It's so rare to see true electical capture achieved in the field I'm sure we'd all learn a lot from the case. In my experience the ED physician wants to see the underlying rhythm anyway. I remember on one occasion the pacer was turned off and there was (almost) nothing underneath. They turned it right back on and took the patient up to the cath lab with our LP12 attached. Not sure what happened when they got there but one of the nurses brought back our machine.

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Hey Tom, love the twitter feed. I just finished reading the Adenosine story. You should bring it here in the scenarios. :)

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Normally anytime we started pacing in the field we would call ahead to the ER. The ER staff would have their crash cart in the room with their pacing equipment setup and they would also have some Dopamine hanging and ready to go. We used the same pads, so they would usually turn our pacer off, run a strip and then start pacing with their own equipment if need be.

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Every paced patient that I transferred had us quit for the ER doc to assess then restart using the receiving hospital's equipment.

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So, last week I got called to do an interfacility run with a client in 3rd degree block. I arrived at that hospital, her pressure is 98/65 and they are pacing her at a rate of 60 beats per minute at 80 ma. Also running an IV bolus to maintain her BP. Doc is no where to be seen, never saw him for the 20 minutes I was there. I introduced myself to my client and checked her radial pulse. 35 bpm. I look at the nurse and asked her if they actually verified that they had mechanical capture. She said she told the doc the heart rate was slow, but he said it was fine. Then I asked why no vasopressors were hanging, doc didn't want any up. I got her into my unit an started an epi infusion but had to keep pacing, I got mechanical capture at 110 Ma.

I arrived at the CCU 2 hours later and transfer my client over. CCU nurse #1 applies the monitoring electrodes and transfers the pacing electrodes to her machine. Then, with no ECG showing on the monitor, she cranks the Ma up to 200. "Whoa whoa whoa!!! I got mechanical capture at 110, you're defibrillating her!!" Nurse #1 turns it down but still couldn't get the ECG to show on the monitor, CCU nurse #2 comes to help and says "You have to have it set to paddles." Fortunately, my monitor was still connected, so I could see what was happening, but I was behind the 8 ball with this poor lady for my entire trip, trying to keep her adequately sedated, she used up all my versed. Needless to say, I had little patience for...well...I won't say it. I told them, "No, you can't monitor through the paddles when they are being used for pacing, you have an electrode off." I put it back on and showed her rhythm.

Seriously, I dunno what scares me more, the incompetence of the doc, who I could forgive because he's small town and not exposed to this stuff much....or a highly trained and supposedly competent pair of CCU nurses who couldn't properly apply a TCP they've used in their department for years between them.

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Posted · Report post

Not sure about how the LP 12 handles, but I believe the Zoll's we have, and the hospital too, can have pacing set up without the pads. So take the hospital machine, match the settings to your machine, then switch the pads. I'd try and make it a timely and coordinated operation.

Speaking of this, anyone have the 4:1 button on their Zoll to take a look at the underlying rhythm? I tried it to see the underlying rhythm, because I couldn't believe it would show the underlying rhythm while pacing. How it works I have no clue, but it showed me a nice slow rhythm



So, I just went to the ambulance to test it, for the Zoll, you can disconnect the pads and set up the pacer. Just to let y'all know...

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