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From Flashcardlet > Pacemaker Complications & Defibrillation > Flashcards

Pacemaker Complications & Defibrillation Flashcards

0
Q

What means that there is a pacer spike, and then nothing happens so it didn’t trigger a beat?

A

failure to capture

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1
Q

What is an example of capture?

A

pacer initiates electricity, the heart depolarizes

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2
Q

What are causes of failure to capture?

A
  1. dislodged lead
  2. perforation
  3. ischemic areas of heart
  4. antiarrhythmics can affect
  5. electrolyte imbalances can affect
  6. exit block
  7. insulation break
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3
Q

What is another cause of failure to capture that happens when people can’t help but mess with site, especially when it is new and they can actually disconnect the leads from the pacemaker?

A

Twiddler’s Syndrome

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4
Q

How do you help prevent the lead disconnecting with Twiddlers Syndrome?

A

put the arm in a sling to keep it still

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5
Q

How do you measure voltage in a pacemaker?

A

miliamperes

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6
Q

If you turn voltage down, what happens to capture?

A

you don’t get it

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7
Q

If you turn voltage up, what happens to capture?

A

you consistently get it

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8
Q

What is the point at which you consistently get capture ?

A

stimulation threshold

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9
Q

After you find the voltage where you have consistent capture, what do you do to make sure it really is the stimulation point?

A

turn it down a little to lose capture

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10
Q

After turning voltage down to verify it is the stimulation point, what do you do?

A

turn it up 1 1/2 to 2 points above threshold and this should provide consistent capture

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11
Q

What happens when the pacemaker does not sense natural activity and competes with the heart?

A

Failure to sense

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12
Q

What do you see on the ECG that shows failure to sense?

A

You see pacemaker activity in places where you shouldn’t

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13
Q

What is dangerous about failure to sense?

A

If the pacemaker were to fire during the vulnerable period of the T wave, you could cause v tach

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14
Q

How do you correct failure to sense?

A
  1. Decrease amplitude

2. Reposition tip

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15
Q

What is inhibition of the pacemaker by events the pacemaker should ignore (like T waves, movement, etc…)?

A

Oversensing

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16
Q

What is failure of the pacemaker to sense intrinsic R-Waves or Intrinsic P waves?

A

Undersensing

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17
Q

What is seen on the EKG with undersensing?

A

See spikes when you shouldn’t

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18
Q

How long is someone in a sling post pacemaker insertion?

A

24-48hours

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19
Q

Why are they put in a sling after pacemaker insertion?

A

to prevent excessive movement

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20
Q

What is a pulmonary complication with subclavian puncture?

A

pneumothorax

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21
Q

What injurys could happen with subclavian puncture?

A

Subclavian artery injury

Brachial plexus injury

22
Q

What can form on the clavicles from subclavian puncture?

A

bony spicules

23
Q

What are other complications of subclavian puncture?

A

Hematoma
Air embolism
Thrombosis
Infection

24
Q

Why is infection a major problem with subclavian puncture?

A

There is a foreign body in the heart in a blood source

25
Q

What are complications with pacemakers that can happen at home?

A

electromagnetic interference

26
Q

What are examples of things causing electromagnetic interference?

A

Amateur radio, ignition cables, appliances, power tools,

27
Q

What may be dangerous to do at home with a pacemaker?

A

electric arc welding

28
Q

What can cause electromagnetic interference in the hospital?

A

a. Defibrillation
b. Electrosurgery / Electrocautery
c. Diathermy
d. Ultrasound Therapy
e. Magnetic Resonance Imaging

29
Q

When defibrillating a patient with a pacemaker, how far should the paddle be from the pacemaker?

A

1-2 inches away

30
Q

How often do you check on a patient who was defibrillated with a pacemaker?

A

check them immediately and few days later

31
Q

What is apparently hard to ground – used to affect pacemakers all the time?

A

Electrosurgery / Electrocautery

32
Q

How long does an average pacemaker battery last?

A

8-10 years

33
Q

How much warning does the battery give when it is getting low?

A

a year or two

34
Q

What does the pacemaker alter to indicate it needs charging?

A

the pacemaker will alter the rhythm by a set amount (either faster or slower)

35
Q

What do patients need to do to check if their pacemaker is getting low?

A

have regular checkups

36
Q

What is the process whereby current is passed through the heart to depolarize the cells and allow them to repolarize uniformly in an organized, coordinated contraction?

A

depolarization

37
Q

What is the most effective method to terminate V. Fib?

A

Depolarization

38
Q

The chances of success reduce how much with each minute you do not depolarize?

A

7% to 10%

39
Q

What is output of defibrillator measured in?

A

joule or watt second

40
Q

How much energy should be delivered with defibrillating?

A

enough to get the job done but not too much where you damage muscle

41
Q

What do you put on paddle to help deliver electricity and prevent burning patient?

A

gel

42
Q

What are the determinants of resistance to defibrillator discharge?

A

see powerpoint

43
Q

What should electrode pressure be?

A

11kg/25lb

44
Q

where do you position the paddles for anterior / posterior position?

A

under left clavicle and under left scapula

45
Q

Where does the charge go with a monophasic defibrillator?

A

from paddles to patient

46
Q

Where does the charge go with biphasic defibrillator?

A

paddles to patient to paddles

47
Q

With monophasic, how many joules/watt sec should be delivered with first shock?

A

200

48
Q

With monophasic, how many joules/watt sec should be delivered with 2nd shock?

A

200-300

49
Q

After the 2nd shock, how many joules/watt sec are delivered with monophasic?

A

360 and no more

50
Q

How much strength is delivered with biphasic all the time?

A

150 joules/watt sec

51
Q

What is the difference between cardioversion and defibrillation?

A

the ability to time the cycle to deliver current on QRS and not T wave

52
Q

When do you only use cardioversion?

A

When patient is stable

53
Q

What is the #1 choice of hemodynamically stable tachycardias?

A

cardioversion

From Flashcardlet (107 decks)

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