Difference between apical pulse and pulse monitored on display

[redeyelpn]

Auscultated irregular apical pulse 37, displaying 66 on monitor, implanted pacer. No observable s/s. What is up with that?

Interested in learning more about the world of cardiology and pacers. Read about this situation from a fb post. Wanted to learn more. Any info appreciated.

(Fairly new LPN)

[akulahawkRN, ADN, RN, EMT-P]

I should have clarified "monitor" being the dynamap

Automatic BP cuffs can become inaccurate when there's an irregular rhythm or when there's some beat-to-beat variability because of frequent PVC's or (in the case of slow rates) escape beats to maintain sufficient perfusion.

If the machine is giving me conflicting info from what I'm actually hearing or feeling, I'm going to disregard the machine and "go manual" on things wherever possible. Then again, I hail from a transport background and I'm very used to doing manual vitals and assessments and having a bit of a healthy skepticism for the machines... They have to earn my trust.

When in doubt, trust your eyes, ears, and fingers. Sometimes they can tell you things about the patient that the machines just can't.

[redeyelpn]

I feel the same way about auto cuffs. Thank you to everyone who has replied!

[firstinfamily, RN]

When in doubt, get the manual out!!! Automatic machines do not sense the irregularity of arrythmias and therefore do not reflect the correct pulse rate!!