what would happen if you defibrillated a pt w/ a pacemaker?

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Hi all!

This has been bugging me, and no one can seem to answer this Q. I have looked on the site, but I haven't found an answer. We once had a patient with an AICD/pacemaker - but he was obese and we didn't know until a day later when a pcxr was done (no family/pt didn't mention it when questioned). I was just curious - hypothetically, what would have happened if we'd thought we needed to shock him? Can anyone answer that? I'm guessing it would fry the AICD, but what would happen to the patient? Also, what do you do when a pt with an AICD goes into runs of V-tach, but the AICD isn't kicking in? We don't get many up here, so please forgive me if these seem like silly questions.

Thanks so much!

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Specializes in Certified Med/Surg tele, and other stuff.

26. Can you shock a patient with a pacemaker?

The last time this came up in the MICU, we called the CCU, and they told us that it’s generally safe to shock a patient with an implanted pacemaker.

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Specializes in Certified Med/Surg tele, and other stuff.

I found this on a pacemaker support club website. Interesting, actually. Otherwise, I have no clue myself. I have heard to not put the pads over the pacer, because it will either burn, fry it, or both? Can't remember...

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Specializes in ICU, Telemetry.

We've had to shock them if the pacemaker failed. I admit, I did have a moment where I was worried the thing was gonna blow out of his chest like an alien in "Aliens" but nothing happened. If we know someone's going bad, I've seen the cardiologist turn off the pacer with a magnet so they could directly control the situation without the pacemaker doing preprogrammed responses.

The big thing is if there's a pregnant nurse/MD/anybody at the code and the patient has a pacemaker, they don't touch the patient. They call pull up meds and hand them to someone else, run for extra meds if the code cart's running dry, deal with the family/lab/emergency transport or whatever. I had a friend get shocked while 7 months pregnant because (like your case) the AICD was so buried in adipose that no one could tell anything was there. She felt the shock, and half the floor took off with her to L&D to get her checked out. She and the baby were okay, but it scared the buhjeezus out of all of us.

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Specializes in Electrophysiology, Medical-Surgical ICU.

Just renewed my cpr last week I was told still shock just put the pads at least an inch away from the pacemaker

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Specializes in thoracic ICU, ortho/neuro, med/surg.

If they are dead, you should shock them, pacemaker or not.

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Specializes in ER/ICU/STICU.

If they need to be shocked than they need to be shocked. As someone else mentioned, I have seen docs use the magnet to turn off the pacemaker.

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Specializes in Med/Surg.

You can still shock someone with a pacemaker, just don't place the pads over the pacer, obviously if you're coding someone their pacer/AICD has failed.

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Specializes in Emergency/Cath Lab.

Shock away! Just dont put the pads on the pacer or be ready for some fun.

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If they're in a shockable rhythm and the PM/AICD hasn't taken care of it, then it's not doing it's job and might be broken anyway. Now where it would be a little sketchy would be if the pt's rhythm was completely dependent on the PM.

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If they have a pacemaker, and they need defibrillated then shock them. some pacemakers will try to 'burst pace' a patient out of a fast rhythm, but a pacemaker does not have enough joules to defibrillate. If they have an AICD/pacemaker, and it is has not converted the pt, then shock them, obviously the AICD/pacemaker has failed, and the pt needs help. Defibrillating with pads/paddles smothers the heart in electricity, so to speak, which will then hopefully end the vtach/vfib, and you can progress the ACLS algorythm from there.

I've shocked with Pacemakers, AICD/pacemakers, external pacemakers with transcutaneous pacer wires, and temporary transjugular pacemakers.

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Every ICD is a pacemaker, but not every pacemaker is an ICD.

Magnets DO NOT "shut off" the ICD. It will put it in an asynchronous mode which inhibits the defibrillation function, not the pacing. An interrogation of the pacemaker is needed to stop the pacing function. But the pacemaker is always on and reading the patient, unless the battery is dead.

"but a pacemaker does not have enough joules to defibrillate." - Correct, pacemakers don't defibrillate. However ICD's do, and when they do, they shock with 35 joules which is roughly equivalent to 700+ volts. The voltage is directly on the heart, not through layer of fat. If you don't think that is enough to shock a heart, you might want to reevaluate anatomy and physiology.

An ICD has an upper limit. If the HR goes above that the ICD will try to outpace it to convert the heart back. If that does not happen and the patient goes into V-Fib/V-Tach, it will shock up to 7 times (depending on the manufacturer), then stop shocking.

Nick

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