snatchgripRDL

Switching to hospital pacer after transport

15 posts in this topic

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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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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