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.