what i want to know is, why did u put a magnet on the pm that got him so mad? i am sure it wasnt just for the hell of it!
and i also dont agree with him that the machines are the smartest things in the room-by any means. that is why u treat your pts, not the machines....
s(bleep), people scratching themselves can look like vt if u only watch the monitor!!
=lifelongstudent]so they put in a internal defib r/t bouts of v-tack or even bradycardia episodes...okay stands to reason there...this week she complained that it went off...okay i didn't panic..that is what they put them in for right?!?!? so i charted and monitored her closely...all vs were wnl (actually better than a month ago!).... but then it went off another time in the middle of the night...
i am just taking a stab at this but here goes:
when the internal defibs. discharge, aren't they supposed to make a little noise to warn the patient -- "hey, here it comes! get ready". if hers is not giving a warning "beep", then maybe her cardiologist can enable this function so it won't freak her out next time it happens (and btw - i agree with driving home the point that this is exactly what those little gadgets are supposed
to do). the shock gives you quite a little kick from what i understand -- it would probably scare anyone, so maybe that is why she panicked (plus it is a new experience for her).
i am sure she was told all of this by the ep doc, cardiologist, nurses, etc... but sometimes people just don't hear it (even when they are shaking their head yes... go figure), so maybe a little more (re)education is called for. also explain about the lifespan of the battery and how it can fluxuate from patient to patient depending on how often they require defibrillation. with all her misfortune, don't want her to be bent out of shape thinking that she got a bad battery that only lasted 5 years when mary's next door has been in 8 years.
stupid question, but i guess she was not on telemetry on your floor -- would have been nice to have been able to see what was going on with her ecg. another question for you (can you tell i'm a student)... what if she had a 6 beat run of pvcs -- that qualifies as vt - right? but yet she might not be that symptomatic. how quickly do the icds defibrillate? if the answer is milliseconds (instantly), then that could be a possibility of why it is discharging without her being symptomatic -- or -- maybe she is symptomatic (sob, diaphoretic), but she attributes that to her long-term brittle iddm rather than her new onset cvd ?????
i just keep hearing the words of one of our cardiologists playing over and over in my head: "if you ever put a magnet over one of my patients again, i will hurt you! that icd is the smartest thing in this room, me included". i am paraphrasing (wasn't in the room) and he is a little dramatic, but it made an impression on me: trust the gadget.
those are just my (simplistic) thoughts
. i enjoy reading these types of posts as they get me to thinking "what if" not to mention that i gain lots of valuable info from the posts/responses....so educate me with your replies!