DwayneEMTP Posted December 18, 2007 Share Posted December 18, 2007 [/font:4c0211515b] ... the medic said being as the pt had a pacemaker it would defeat the purpose of the running the strip...:wink: Yeah, the medic was certainly talking out his rear. There are many different kinds of pacemakers, but there must still be perfusion, acceptable electrolyte conditions, room for the heart to beat, and on and on. To say that you don't need to know (not you of course, but a general 'you') what the heart is doing because "if they have a pacemaker the heart must be working fine" is insane. If you're portraying this medics comments accurately, go to any beginner EKG site and within two hours you will be able to give him/her a clinic on cardiology. Great question. Dwayne Link to comment Share on other sites More sharing options...
scott33 Posted December 18, 2007 Share Posted December 18, 2007 What ^ said... Your "medic' may need reminding that there has been many a pacemaker, which has produced a perfectly synchronized series of pacing spikes at 80BPM, on a long-since expired patient. As has already been mentioned, there are a few different types of pacemaker - A-paced, V-paced, dual chamber, demand, Pacemeaker / defibrillator etc. The demand devices, for example, only fire when they are required to, so most of the time you will have a normal looking EKG. Pacemakers are also not entirely free from the odd electromechanical hic-up, and they often have to have computerized interrogation, to make sure everything is in sync, and correct it if it is not. As for the patient, treat her like you would any other, and in the correct order. Link to comment Share on other sites More sharing options...
FireParamedic Posted December 28, 2007 Share Posted December 28, 2007 I think what this medic is also forgetting, is that there is a current recall on some of the internal defib/pacer wiring. He might have been looking at one of the defective units. I ALWAYS put my pt. on the monitor. How else will you see any changes??? X-ray vision?? Back to training folks. O2, Monitor, IV. It was taught for a reason, not just so you can bill for it. Link to comment Share on other sites More sharing options...
captainstandup Posted December 28, 2007 Share Posted December 28, 2007 Medtronic and Guidant have experienced some really serious issues with their implanted devices lately. Perhaps the device failed or for whatever reason the patient has "lost mechanical capture" and was at that point not truly being paced by the device. This could easily result in low cardiac output, confusion and lethargy. Of course we are going to consider the other disease processes and fully assess the patient. In my opinion a Medic that fails to FULLY assess and gather information utilizing a combination of education, training and clinical judgment all supported by some really expensive electronics is dangerous. Link to comment Share on other sites More sharing options...
zzyzx Posted January 1, 2008 Share Posted January 1, 2008 Did the medic have the patient on the monitor (3-lead)? He may have had the patient on the monitor, seen that he was in a paced rhythm, and decided that a 12-lead would not be of much value. You would not be able to diagnose ST changes or BBB's if the pacemaker is firing the ventricles. Link to comment Share on other sites More sharing options...
Inf Posted January 2, 2008 Share Posted January 2, 2008 To play devil's advocate, if the patient appears hemodynamically stable and V/S were stable then BGL determination and stroke assessment would take priority over running an EKG strip. If you suspect cardiac condition as a cause of poor perfusion you would see the s/s of poor cardiac output DURING your initial assessment and vital signs. We are talking about EKG/BGL after the BP, RR, Pulse, skin color/temp/condition have been obtained, so to say that EKG is not first priority I would agree. Could be your garden variety dementia or TIA/CVA Link to comment Share on other sites More sharing options...
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