I responded to a code blue, MD was already at the bedside because he was responding for new symptomatic hypotension. Patient was admitted two days prior for NSTEMI, and there was plan for cardiac catherization but Cr was elevated so plan to cath when creatinine stabilzed.
EKG was performed immediately prior to code which revealed a failure to sense from patient's PPM. Whenever we did a rhythm check, the rhythm was difficult to discern while the PPM was also firing irregularly. It looked like VT for a brief second, and then I would see a spike and then an irregular non-organized rhythm, and then a spike. Pulse was noted once, before it could no longer be palpated.
Should I have placed a magnet over his pacemaker? Is there an indication for a magnet during a code?
Placing a magnet over a pacer will make it pace asynchronously. (While placing a magnet over an ICD will ONLY turn off tachy therapies and do NOTHING to pacing) If prior to the code blue, the patient's pacer had "failure to sense", placing a magnet over it would probably not help. Just remember, "you can't pace a dead heart". If the patient's intrinsic rate is above the pacing setting it shouldn't pace. Some pacers will pacer at the rate response setting if the device is giggled (if CPR was being done). This is because the device thinks the patient is running, walking up steps etc, requiring a faster heart rate. Always remember to Do CPR when a pulse is not felt. Shock when appropriate. It is easier for the pacer to work when the patent is in SR or even AFib. If the patient is in VF, pacing spike will not capture. If the patient is in VT, you could try to anti tachy pacer.