Pacing & Anesthetic Management For CIEDs Flashcards Preview

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Flashcards in Pacing & Anesthetic Management For CIEDs Deck (160)
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1

What is the preferred pacing method in an emergency?

Transcutaneous

2

What energy does transcutaneous require to obtain capture?

40-80 mA

3

transcutaneous pacing shows (atrial, ventricular, both) pacing

ventricular

4

What are 2 options for transesophageal pacing?

1. Awake patients: swallow a pill electrode that is connected to a pacing wire

2. Sedated patients: flexible catheter connected to a pacing wire

5

transesophageal pacing paces the (atria, ventricle, both)

atria

6

What current does transesophageal pacing require to obtain capture?

20 mA

7

When is transvenous pacing used?

when a patient is stable or when transcutaneous pacing is not working

8

How is transvenous pacing placed?

through a central line

9

Transvenous pacing can pace (atria, ventricles, both)

both with atrial and ventricular leads

10

Which pacing method provides the most effective capture?

transvenous

11

What current does transvenous pacing require?

1.5-3 mA

12

When do you encounter epicardial pacing?

when the chest is open during cardiac surgery
-leads are sewn into the myocardium

13

Name 4 temporary pacing methods

1. transcutaneous
2. esophageal
3. transvenous
4. epicardial

14

A CIED is a (temporary/ permanent) pacemaker

permanent

15

A CIED has a ______ connected to pacing wires that are inserted into the heart via the ______

pulse generator
-SA node

subclavian vein

16

What are the 3 types of CIEDs?

1. Pacemaker
2. AICD (automated implantable cardioverter defibrillator)
3. CRT (chronic resynchronization therapy) device
- biventricular pacemakers

17

What are the 2 primary reasons a patient would need a pacemaker?

1. to pace patients with slow heart rates

2. to improve the timing of atrial and ventricular beats in patients with complete heart block

18

What is a single chamber pacemaker?

When pacemaker leads are inserted into the right atrium OR the right ventricle

19

what is a dual chamber pacemaker?

When pacemaker leads are inserted in BOTH the right atrium AND the right ventricle

20

Where is the lead located in an ICD and what does it have?

right ventricle

has a built in shocking coil that can sense and shock tachyarrhythmias

21

What 3 things can intravascular ICDs do?

1. pacing
2. synchronized cardioversion
3. antitachycardia pacing (defibrillation)

22

What are subcutaneous ICDs used for?

defibrillation only

23

Where are the leads in a biventricular pacemaker?

one lead in the right ventricle and a second lead guided into the left ventricle through the coronary sinus

24

How is the pulse generator for the ICD programmed?

by the pacemaker rep

25

How does the pacemaker rep test an ICD in surgery?

the rep purposely places the patient in Vfib and then will shock them back into sinus rhythm

26

When testing the ICD in surgery, what should the anesthetist be sure to do?

give a small propofol bolus prior to shock delivery

27

____ refers to cardiac cells responding to pacemaker stimulation

capture

28

_____ refers to the minimum current level at which capture is observed

pacing threshold

29

_____ is the current at which the pacemaker maintains capture

maintenance threshold

30

What should the maintenance threshold be set at?

10% higher than the pacing threshold