Pacemakers

[GoldenFire5]

I'm about two months into a new job at an urgent care. 50ish male came in, cardiac hx, decision had been made to transfer to ER, paramedic transport called and on their way. Pt was on a cardiac monitor, and I was preparing to insert his IV.

So I'm palpating his R ac, and he said: "ow, ow, you're shocking me!" I asked him where was I shocking him, and he pointed to his implanted defibrillator. Rhythm on the monitor was showing what I believe was brief runs of a fib, going back into sinus. I go to get help, all the other nurses were in pt rooms, so I ask the provider to come eval. Of course when two of the providers came out, pt was in sinus rhythm, no distress. They looked at me like I had two heads and said the pt would KNOW if his defibrillator was shocking him.

So, my question is, how does a pt know if his defibrillator is firing? Is it sometimes a small shock, sometimes a larger one? Could it have been a small one to take him out of a fib? Do you hear anything audibly when it happens?

Thanks. :)

[Virgo_RN, BSN, RN]

Do you mean V Tach? A Fib is not an indication for AICD placement, and I doubt an AICD would fire for A Fib, unless the person was having a rapid ventricular response. From what I've heard, the sensation of the AICD firing is very noticeable to the person experiencing it. They know when it's happening.

[RN1989]

They generally feel like they have been kicked in the chest by a mule when their ICD fires. They KNOW it when it goes off.

Considering the gender of this person along with a "young" age of needing and ICD - he was probably being a weenie and allowing anxiety and the stimuli of the environment to get to him since he knew he was about to get poked.

[GoldenFire5]

Thank you - no, he was definitely not in v tach or v fib. He was anxious about the situation, that's true, that was probably it. It could have been that he was trying to point to his left arm to show me he didn't like that I was palpating his vein. His vein was a zig-zag, I was worried I wasn't going to get an IV in there, but it was fine.

[kmoonshine, RN]

I agree with everyone else - if his implanted defib. fired, he'd definately know it.

I once had someone come in (he had both a pacer and defib), and he said he had felt the defib fire for the first time - and it was like lightning hit him in the chest. I was calling report to the tele floor, and heard the main tele monitor alarming - I took a look, and he was in v.tach. Scared me to death, and probably scared him too! We all ran into his room, and he was sitting upright looking like he had just seen a ghost! Thankfully, his defib was working and kicked the run of v.tach! And, you don't hear anything if the pt's defib fires.

[akvarmit]

I agree with the above posters - and if it really fired - YOU probably would have known it too!

See the web page below under the topic "what should I do if I get a shock" - it talks about warning family members that if a shock is delivered while someone is touching them, that person may also feel a mild shock and should be fore-warned.

http://www.rochestermedicalcenter.com/implantable_defibrillators.htm