So I'm in clinical today...

[Bicycleboy]

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?

[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

[Danish, MSN, APRN, NP]

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

Funny you should say that. My instructor always says, "Treat the patient, not the monitor!"

[Daytonite, BSN, RN]

ah, bicycleboy, you were probably a mechanic or an engineer in a former life. what you need to do is get a copy of the mechanical specifications or go to the website of the manufacturer of the particular model of the vitals machine you were using to take this patient's heart rate and see just how the equipment computes the heart rate. most of these gadgets have some type of computerized chip in them that compute a rate based on a mathematical formula that detects some type of signal in the body that gives it that mathematical number to start with. the big question is what body signal is the machine detecting that allows it to ultimately end up with pulse rates that are 2 or 3 times that true rate? that is your assignment if you care to accept it! i stopped using digital b/p cuffs on patients with irregular heart rates for the reason that these cuffs determine the reading based on the fact that the heart rate is regular. when it's not, the b/p reading is way off.

by the way, i want you to know that i am very impressed that you would take the time to sit and talk with the patient. i wish more nurses would do this. it really doesn't take up as much time as they think. it imparts a sense of caring to the patients. it also gives your back a rest, something i wish i'd done a lot more in my earlier nursing days now that i have a bad back.

[Bicycleboy]

ah, bicycleboy, you were probably a mechanic or an engineer in a former life. what you need to do is get a copy of the mechanical specifications or go to the website of the manufacturer of the particular model of the vitals machine you were using to take this patient's heart rate and see just how the equipment computes the heart rate. most of these gadgets have some type of computerized chip in them that compute a rate based on a mathematical formula that detects some type of signal in the body that gives it that mathematical number to start with. the big question is what body signal is the machine detecting that allows it to ultimately end up with pulse rates that are 2 or 3 times that true rate? that is your assignment if you care to accept it! i stopped using digital b/p cuffs on patients with irregular heart rates for the reason that these cuffs determine the reading based on the fact that the heart rate is regular. when it's not, the b/p reading is way off.

by the way, i want you to know that i am very impressed that you would take the time to sit and talk with the patient. i wish more nurses would do this. it really doesn't take up as much time as they think. it imparts a sense of caring to the patients. it also gives your back a rest, something i wish i'd done a lot more in my earlier nursing days now that i have a bad back.

i am a student so i only have 2-3 pt's, so i always make sure to take the time to talk to them. even when i do psw stuff, i always tell myself that i am going to take the time during my shift to sit and talk with at least one resident, even though i am taking care of 15. i would rather know somwthing about the person if i am going to be taking care of them.

funny you mention engineer, because before i decided to go to nursing school i used to design hydraulic and pneumatic systems for people, and i was about an inch away from going to school to become a hydraulics engineer.

i figure the gizmo on the spo2 meter picks up electrical signals from the heart that are transferred across the skin, but after seeing what i saw i am thinking that the pacemaker is emmiting at a slightly different frequency than the nodes of the heart do, but i can't say that this is true. i think from now on i am going to do things the old fashioned way, it will also make me better at doing that stuff, so eventually i will be my very own vitals machine.

[queenjean]

I have noticed on our portable vital signs machines that sometimes it will double or triple the pulse; particularly if the pulse is slow and bounding or irregular.

I always assumed it was reading either a mechanical pulse (like on the bp cuff) or through the pulse ox, sensing the pulsation/movement of blood; isn't the pulse ox based on a technology similar/related to ultrasound? I've honestly never thought too extensively about it until now!

[brissie]

Treat your patient, not the machine! If they had had a heart rate that high then they surely would have had some other signs or symptoms going on.