Pacing and CIED's Flashcards
Lance Carter, AA-C (104 cards)
1
Q
Temporary Cardiac Pacing (4)
A
2
Q
Transcutaneous Pacing
A
3
Q
Disadvantages to Transcutaneous Pacing (3)
A
4
Q
Placement Options for Transesophageal Pacing (2)
A
5
Q
Advantages/disadvantages to Transesophageal Pacing (4)
A
6
Q
Temporary Transvenous Placement (3)
A
7
Q
Advantages (3) & Disadvantages (2) to
Temporary Transvenous Placement
A
8
Q
Epicardial Pacing
A
9
Q
Cardiovascular Implantable Electronic Devices (CIEDs)
A
10
Q
Three types of CIEDs
A
11
Q
Two primary reasons for a patient to receive a pacemaker (2)
A
12
Q
Automated Implantable Cardioverter Defibrillators (AICDs) (2)
A
13
Q
Biventricular pacemakers
A
15
Q
Capture Threshold
A
16
Q
Normal Capture Ranges (Normal “Pacing Threshold”)
A
17
Q
Maintenance & Sensitivity Threshold
A
18
Q
Potential sources of heart beats in patient’s with pacemakers (2)
A
19
Q
Demand Mode
A
20
Q
Pacemaker “Sensing”
A
21
Q
The Effect Of Cautery On Pacemakers
A
22
Q
Pacemaker Dependent Patients
A
23
Q
Asynchronous Mode
A
24
Q
The Problem With Asynchronous Mode
A
25
The Advantage of Asynchronous Mode
26
Pacemakers should only be placed in asynchronous mode if (2)
27
Clinical Use Of Asynchronous Mode
28
Converting Pacemakers To Asynchronous Mode
29
How does rate modulation work?
30
Antitachycardia Pacing (ATP)
31
Indications For A Pacemaker (5)
32
What type of pacemaker should be used for this patient?
–Atrial? Ventricular? Or dual chamber (atrial + ventricular)?
Atrial
33
What type of pacemaker should be used for this patient?
–Atrial? Ventricular? Or dual chamber (atrial + ventricular)?
Ventricular
Because constant atrial activity would not allow the pacemaker to pace if it were only in atria
34
Single Chamber Pacemaker (in the Right Ventricle)
35
What type of pacemaker should be used for this patient?
–Atrial? Ventricular? Or dual chamber (atrial + ventricular)?
Dual-chamber
Complete AV block and atrial lead is used to "sense" atrial activity
36
Fixing Complete Heart Block With Pacing
37
Single Chamber Pacemaker for Complete Heart Block
38
Dual Chamber Pacemaker With A Normal ECG
Intrinsic rate is faster and SA/AV are working fine
39
Dual Chamber Pacemaker With Atrial Only Pacing
Patient has a slow SA node, but normal AVN conduction
40
Dual Chamber Pacemaker With Ventricular Only Pacing (Most common)
Normal SAN function, but complete heart block present
41
Dual Chamber Pacemaker With Dual Chamber Pacing
SAN/AVN both are non-functional (Sinus bradycardia and complete heart block present)
42
Biventricular Pacemaker
43
Why Have An Additional Lead In The Left Ventricle? (2)
44
Implantable Cardioverter Defibrillator (ICD)
45
Traditional (Intravascular) ICD
46
Subcutaneous ICD (S-ICD)
[https://www.youtube.com/watch?v=1qXOYO7qiGs](https://www.youtube.com/watch?v=1qXOYO7qiGs)
[https://www.youtube.com/watch?v=y5paLXRG6Go&t=11s](https://www.youtube.com/watch?v=y5paLXRG6Go&t=11s)
47
Advantages To The Subcutaneous ICD (S-ICD)
48
Disadvantages To The Subcutaneous ICD (S-ICD) (3)
49
ICDs In The Operating Room
50
Preventing Accidental Shock From An ICD During Surgery (2)
1. One way to prevent accidental shock from an ICD during surgery is to **disable the shock function** of the ICD
–A pacemaker rep can do this by reprogramming the ICD prior to surgery, but the most common way we do this is to **place a magnet over the ICD** in the OR
2. The second way to prevent accidental shock from an ICD during surgery is to keep electrical current (i.e. cautery) away from the ICD
–One way to do this is to **place the grounding plate as far away from the ICD as possible (at least 15cm)**
–The other way to do this is for the surgeon to use an alternative to unipolar cautery (like **bipolar cautery or a harmonic scalpel**)
51
Advantages/disadvantages to a Harmonic Scalpel
52
Magnet Application On ICDs
53
Magnet Placement On An ICD
54
Clinical Management Of ICDs (2)
55
No shock. Bradycardia/possible asystole
1. Put a magnet on
2. Bipolar cautery or harmonic scapel
56
Pacemaker interrogation
[https://www.youtube.com/watch?v=ZO3GybKgJPU](https://www.youtube.com/watch?v=ZO3GybKgJPU)
57
How often should pacemakers and ICDs be checked?
58
Preop Management of CIEDs
59
What Anesthesia Should Know Preop (6)
1. What type of device are we dealing with ? (pacemaker vs. ICD)
2. What is the programmability of the device? (i.e., VOO, etc)
3. What is the underlying rhythm? (why was the pacemaker placed?)
4. Is the patient is pacemaker dependent?
5. Does the pacemaker have rate modulation?
6. Does the pacemaker capture effectively?
7. What is the magnet response?
8. Is there adequate battery life? (\> 3-6 months)
9. What are the manufacturer’s perioperative recommendations?
60
Intraoperative Management
61
Postop
62
CIED Algorithm
63
Yes she is pacemaker dependent.
1. Call rep or put pacing pads on
2. Bipolar cautery or harmonic scapel
3. Transcutaneous pacing
Nothing, it will stop pacing and causing bradycardia or asystole
64
No he is not pacemaker dependent
Magnet placement will convert the pacemaker into asynchronous mode and increase HR
No a magnet should not be placed on this patient
Zero effect of cautery on his heart rate
65
Not required but dependent on the provider
Magnet placement would disable the shock function
66
Magnet placement will disable shock function and will not change EKG and still in demand mode
Yes, a magnet should be placed
67
Place magnet
68
Rep needs to activate asynchronous mode
69
Rate modulation was not disabled
70
1st Letter In The Pacemaker Classification Code
71
2nd Letter In The Pacemaker Classification Code
72
3rd Letter In The Pacemaker Classification Code
73
When The 3rd Letter Is “I”
74
When The 3rd Letter Is “T”
75
An Example Of Triggering
| (When The 3rd Letter Is “T”)
76
When The 3rd Letter Is “D”
77
When The 3rd Letter Is “O”
78
4th (Programmability) & 5th Letters
79
AAI Pacing
80
AOO Pacing
81
VVI Pacing
82
VOO Pacing
83
DDD Pacing
84
DOO Pacing
85
VDD Pacing
86
MRI & CT Scans
87
Radiation Therapy
88
RF Ablation, Emergency Defibrillation
89
Transcutaneous Electrical Nerve Stimulation (TENS)
90
TENS & CIEDs
91
Electroconvulsive Therapy (ECT)
92
Cardiovascular & Cerebral Effects of ECT
93
Methohexital
94
Etomidate
95
Propofol
96
Ketamine
97
Airway Management For ECT
98
Neuromuscular Blocking Agents For ECT
99
CIED Implications For ECT (4)
100
Extracorporeal Wave (ESW) Lithotripsy
101
Synchronized Litho Shocks
102
Non-Synchronized Litho Shocks
103
CIEDs may interpret these the shocks the same way they interpret cautery. This could cause:
104
How does synchronized litho shocks can cause arrhythmias in atrially paced patients?
