So I'm in clinical today...

  1. and assessing a pt with CHF, renal failure, and a pace maker. I figured there would be an interesting history, so I decided to sit and talk and let the vitals machine do its thing. Then I notice a heart rate of 270, then 140. I figure I'll bite, so I get a radial pulse of 58. Being the curious person that I am, I figure cool, I might have some sort of pulse deficit here, of course I don't think it is a pulse deficit of such a massive proportions, and the pt is sitting there relaxed. So I figure an apical pulse is in order, a rock steady 61.


    All of the sudden the squirrel wheel in the attic starts spinning, ok, pacemaker + electrical sensing device = your better off doing the old fashioned way.

    Well, after all that I figured that I would trust my senses and chart 61. So I figured I would check the previous HR's, wow most of 'em are up round 120-140.

    Now I know I am nothing special, and don't claim to be. So, am I missing something here?
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    About Bicycleboy

    Joined: Aug '05; Posts: 64; Likes: 5
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    17 Comments

  3. by   meandragonbrett
    What is the reason for the pacemaker? Dinamaps aren't always correct.
  4. by   EricJRN
    Were you able to identify any particular rhythms on the monitor?
  5. by   Bicycleboy
    I think that the machine was getting screwed up from the pacing, if the machine were really that buggered I would think that someone might wonder why half the floor is tachy.

    Do you think that the pacemaker influenced the machine, and if it did would they not teach that?

    I used to think it was me that could not get things right, I am starting to doubt that now.

    Quote from EricEnfermero
    Were you able to identify any particular rhythms on the monitor?
    The monitor was just a sensor on a spo2 sensor that gives a number, not a rythym.
  6. by   Achoo!
    Sometimes the pulse ox's take a bit to regulate. The first number you get is not always accurate. It depends on the machine.
  7. by   Scrubz
    It's true that the dynamaps aren't always correct. Sometimes they just bug out and give crazy vitals, and then you reset it and they're back to normal. If you ever get crazy vitals with the dynamap, re-check manually to see if you can back it up. If you get crazy vitals manually then you might want to look into it. But if a dynamap is giving a really high pulse and you check it manually and it's normal and they don't seem to be in any kind of distress, then I wouldn't take the dynamap as seriously. But I'd always check apical pulse and radial pulse just to make sure, since the dynamap is just checking the pulse at the given site.
  8. by   locolorenzo22
    When in doubt, do it manually. Much easier to work then the dyna sometimes. Drs. will want the most accurate vitals and you better have the right ones if you're calling.
  9. by   Danish
    You did the right thing. I might make a note in the chart that you did an apical and maybe see if you can switch the monitor/dynamap.
  10. by   Bicycleboy
    The thing that I find is curious is; was the machine wrong for all the other previous results then charted as the correct? Would not such a high pulse raise an eyebrow, especially in someone with CHF where the heart is being paced? This is where I am wondering if there is something amiss. It is more of a curiosity than anything else.

    I am not saying that when a machine gives a curious result you should call the Doc, but would not one continue to assess?
    Last edit by Bicycleboy on Mar 22, '07
  11. by   Danish
    Quote from Bicycleboy
    The thing that I find is curious is; was the machine wrong for all the other previous results then charted as the correct? Would not such a high pulse raise an eyebrow, especially in someone with CHF where the heart is being paced? This is where I am wondering if there is something amiss. It is more of a curiosity than anything else.

    I am not saying that when a machine gives a curious result you should call the Doc, but would not one continue to assess?

    I wouldnt doubt it if this was just a case of...checking the machine, okay, chart what I see.

    Is this a LTC facility? I have had similar experience in LTC here in Florida in clinicals and as a CNA. I had a pt's chart state that the respirations were 20 every shift for 5 weeks (the pt was COPD on Morphine and resps were 10-12 for the 3 weeks following that I had her)
  12. by   meandragonbrett
    Quote from Bicycleboy
    Would not such a high pulse raise an eyebrow, especially in someone with CHF where the heart is being paced?

    You would be surprised how many folks wouldn't think twice of that HR regardless of the pt's disease processes. You utilized critical thinking in this situation. Good job!
  13. by   Bicycleboy
    Quote from Danish
    I wouldnt doubt it if this was just a case of...checking the machine, okay, chart what I see.

    Is this a LTC facility? I have had similar experience in LTC here in Florida in clinicals and as a CNA. I had a pt's chart state that the respirations were 20 every shift for 5 weeks (the pt was COPD on Morphine and resps were 10-12 for the 3 weeks following that I had her)
    It was the medicine floor of the local hospital.
  14. by   Thedreamer
    Ive had a similar problem before on the step down from ICU. When in doubt, do a manual BP, get an AP and most importantly, monitor the PATIENT not the numbers.

    If the patient is sitting there all cozy watching maury and sipping thier apple juice and your machine is coming back with P: 240 or so something should be sending off red flags in your brain that the machine might either be broken, being interferred with or um.. she lived too close to the nuclear power plant and grew a second heart

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