RESPONDING TO PATIENTS WITH CARDIAC PACEMAKERS AND AUTOMATIC DEFIBRILLATOR

1. RESPONDING TO PATIENTS WITH CARDIAC PACEMAKERS AND AUTOMATIC DEFIBRILLATOR By Corey Thompson

2. OBJECTIVES • Thing I hope you learn • History • What they are • There importance to pt who have them • How they relate to us as EMS professionals and how we deal with them in the field.

3. HISTORY OF THE PACEMAKER • The two inventors: Dr. Mirowski who invented the internal defibrillator and Dr. Bakken who invented the internal pacemaker. • Both inspired by tragic losses. • Both set out to change the way we view cardiology and both were ridiculed and criticized for there work. • Both are now look upon as great inventors and life savers for many.

4. HISTORY CONTINUED • The first Pacemaker was introduced in the 1950s • Not completely implanted • Draw backs - AC powered -Bulky - Painful - Too traumatic for younger patients

5. HISTORY CONTINUED • The first fully implanted pacemaker 1958 • Failed after 2 hours • Seconded lasted 3 days • The first patient to have a internal pacemaker had over 26 during his life time and became known as a pioneer. Arne Larrson died in 2001 at the ripe old age of 86.

6. HISTORY OF THE DEFIBRILLATOR • Before 1950 a patient could only be defibrillated if the chest cavity was open • During the late fifties they developed a way to use paddles on the outside of the body up to a 100 J. • 1960 marked a break through in defibrillators when the first mobile unit was created. • 1980 is when Mirowski came out with the first implanted defibrillator.

7. THE BASIC’S OF THE PACEMAKER • Permanent pacemakers are devices that provide electrical stimuli to cause cardiac contraction during periods when intrinsic cardiac electrical activity is inappropriately slow or absent. They function by sensing intrinsic cardiac electric potentials. If these potentials are too infrequent or absent, electric impulses are mechanically transmitted to the heart, thereby stimulating myocardial contraction.

8. THE BASIC’S OF THE INTERNAL DEFIBRILLATOR • An ICD is a specialized device designed to directly treat a cardiac tachydysrhythmia. If a patient has a ventricular ICD and the device senses a ventricular rate that exceeds the programmed cut-off rate of the ICD, the device performs cardioversion/defibrillation. Alternatively, the device, if so programmed, may attempt to pace rapidly for a number of pulses to attempt pace-termination of the ventricular tachycardia. • They work almost identical to what EMS uses in the field today. • They have rhythm changes programmed into the defibrillator and when one is firing the defibrillator picks up on it and shocks the heart.

9. THE TYEPS/PLACEMENT • Single vs. Duel chambered • Pacemaker/Defibrillator • Two ways to be implanted - Transvenous(subclavian, axillary, or cephalic) and advanced to the right ventricle and/or atrium - Alternatively, epicardial leads can be implanted surgically onto the heart's surface. These usually are used in children because implanted endocardial leads eventually become too short as children grow and are less invasive. - The pulse generator is placed subcutaneously or submuscularly and connected to the leads

10. EXAMPLES OF PACEMAKERS AND DEFIBRILLATORS

11. EXAMPLES OF PLACEMENT

12. THERE IMPORTANCE FOR PATIENTS • Conditions that require a pacemaker/defibrillator: • Sick sinus syndrome • Symptomatic sinus bradycardia • Tachy-bradysyndrome • Atrialfibrillation with a slow ventricular response • Complete atrioventricular block (third-degree block) • Chronotropicincompetence (inability to increase the heart rate to match a level of exercise) • Prolonged QT syndrome • Cardiomyopathy(hypertrophic or dilated) • Severe refractory neurocardiogenicsyncope • Paroxysmal atrial fibrillation

13. THERE IMPORTANCE FOR PATIENTS cont… • For most patients these devices mean life or death. • It is important to understand there function and what the pt condition is, in order to intervene if necessary. • Most pt carry an ID card that states what type they have and what condition it treats.

14. HOW THEY RELATE TO EMS • How we recognize that a patient has one • Visual • Monitor • Conscious pt (ask)

15. HOW THEY RELATE TO EMS • The presence of a Pacemaker/Defibrillator can tell us… • How do we handle pt with them • Treat the pt not the machine • Find out what the pt underlining problem is that the pacemaker/defibrillator supports • Malfunction is the most common reason we respond to patients with pacemaker issues such as: loss of capture, continues shock, dead battery, reprogramming. • Desensitize the unit (be ready to pace the patient if needed) • If shock is required shock around the unit, not on top of it. • The patient needs to be transported to receive technical support

16. ALL PUT TOGETHER • Things you should have learned - History - Understanding the mechanics of the internal pacemaker/defibrillator - The Basics of what the EMS profession needs to know

17. SOURCES • WEB SOURCES • http://www.defibinfo.com/internal-defibrillators-what-you-need-to-know • http://www.medtronic.com/brady/patient/pacemaker_history.html • http://en.wikipedia.org/wiki/Artificial_pacemaker • http://www.nhlbi.nih.gov/health/dci/Diseases/pace/pace_whatis.html