Download Cardiac Pacemakers-corey thompson

By Corey Thompson

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.





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.



The first Pacemaker was introduced in the
1950s
Not completely implanted
Draw backs
- AC powered
-Bulky
- Painful
- Too traumatic for younger patients




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.




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.

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.



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.
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












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



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.

How we recognize that a patient has one



Visual
Monitor
Conscious pt (ask)


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

Things you should have learned
- History
- Understanding the mechanics of the
internal pacemaker/defibrillator
- The Basics of what the EMS profession
needs to know





WEB SOURCES
http://www.defibinfo.com/internaldefibrillators-what-you-need-to-know
http://www.medtronic.com/brady/patient/p
acemaker_history.html
http://en.wikipedia.org/wiki/Artificial_pace
maker
http://www.nhlbi.nih.gov/health/dci/Diseas
es/pace/pace_whatis.html