"Patient has new experimental Pacemaker"

The patient is a 63 y/o male with sudden weakness after putting on coat to go to church. BLS reports trouble getting pulse..."I keep losing the pulse". Fortunately the attending ALS Practitioner is Paramedic Breese. Cardiac auscultation reveals a HR of 30 with reversed split of S2. BP unobtainable. Resp: 18. Patient Cx but very ill appearing. Patient bared from waist up and pacemaker implantation scar noted on L Chest. Pacemaker in less than 1 year. The Paramedic is told that it is a new experimental pacer by a family member.

This very experienced paramedic asked the family member for the home telemetry unit so that he could retrieve the pacemaker magnet. He placed the doughnut magnet over pacemaker and rate increased as indicated. Patient's BP increased to 200/110. IV started and bG+80. Hx HTN with meds: ASA, Aleve, Hytrin, Metoprolol sustained release. Lungs Clear, positive a waves, + JVD while reclining. Patient just c/o weakness and feels like he's "dreaming".

Patient appears better now and the Paramedic and EMT on the call are relaxing a bit when......

Enroute to hospital, the pacemaker fails and the patient develops a 15-20 second run of ventricular standstill. The patient is placed in Trendelenburg and thumped once while getting pacing patches out. Rhythm returns and patient regains Cx. Patient vomits twice, but no other disturbances enroute...

The Cardiologist called the Paramedic later to ask his observations and stated that the pacemaker now shows no signs of malfunction!?!?

Certainly there are indications that there was a failure to sense and a failure to conduct the atrial impulses to the ventricles. By providing early cardiac monitoring and treatment, this paramedic was able to save this man's life and Rule In pacemaker malfunction.

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