5-20-10
Pacemakers and IABP
EKG artifacts: patient shivered, coughed, whatever. Make movement in EKG. Electrical interference.
Movement or not connected well. It can wonder.
Pacemakers – electronic device used to initiate a heartbeat when the intrinsic electrical system cannot
effectively generate a rate adequate to support cardiac output.
2 types: temporary and permanent
Temporary pacemakers always go thru the skin. If anything is hanging out of the patient it’s not permanent.
Indications for pacemakers:
o Speeding heart rates up
o Overdrive pacing – for lowing heart rates down
When you are thinking about code blue think of the pacemaker as a speed up thing
Use them for bradydysrhythmias – anything that is too slow:
o Sinus bradycardia
o Sick sinus syndrome
o Heart blocks
Tachydysrhythmias with a pulse: (if they are without a pulse we will have to defibrillate them)
o SVT
o VT
Permanent pacemaker failure – heart attack or something from surgical procedure, old age, whatever reason it
just quite working. SA node not working and they replace it with a man-made pacemaker.
Used for support after cardiac surgery. If they crack your chest open and go into the heart you will come out
with a temporary pacemaker. So they can increased CO or HR if needed.
Used as a diagnostic study. EP study – electrophysiology study. Looks at the electrical side of heart function.
Room in cath lab and they still go thru the groin. They can shock different places of the heart and see how it
reacts. Tries to get the heart to go into VT to see who the trouble maker is. When they find them they burn
them. They ablate the part of the heart that is making the electrical problem.
Pacemaker System – p. 858
A simple electrical circuit –composed of:
o Pulse generator – battery, what initiates the negative electrical current which is going to cause us to
depolarize.
o Pacing lead – wire that goes to the heart that carries the electricity there to cause the depolarization.
o 1, 2, or 3 electrodes that go to the heart – depends on what type of pacemaker it is.
Temporary pacemaker uses a 9 volt battery. Always have extra one at the bedside, at the very least in the unit.
Change every 24 hours to make sure it doesn’t run dead. Check hospital policy. Also have extra pulse
generator on the unit so if it malfunctions we have another one we can hook up quickly.
Long-term permanent pacemaker which is inside the skin and upper chest, they use a lithium battery. How
long it lasts depends on how often the patient uses it. 100% paced all the time will wear out sooner. Have to
go back to surgery to replace. Settings changes do not require surgery. They can lay something over the chest
and communicate with the pacemaker – called the “Power box”.
Pacing lead – what the negative electricity goes down. Don’t worry about bipolar and unipolar just know
that’s what carries the electricity from pacing generator to the heart. Where the electrodes are connected.
Pacing Routes: Permanent or Temporary
o Transcutaneous (Temporary)
Temporary because its going through skin
Pacemakers and IABP
EKG artifacts: patient shivered, coughed, whatever. Make movement in EKG. Electrical interference.
Movement or not connected well. It can wonder.
Pacemakers – electronic device used to initiate a heartbeat when the intrinsic electrical system cannot
effectively generate a rate adequate to support cardiac output.
2 types: temporary and permanent
Temporary pacemakers always go thru the skin. If anything is hanging out of the patient it’s not permanent.
Indications for pacemakers:
o Speeding heart rates up
o Overdrive pacing – for lowing heart rates down
When you are thinking about code blue think of the pacemaker as a speed up thing
Use them for bradydysrhythmias – anything that is too slow:
o Sinus bradycardia
o Sick sinus syndrome
o Heart blocks
Tachydysrhythmias with a pulse: (if they are without a pulse we will have to defibrillate them)
o SVT
o VT
Permanent pacemaker failure – heart attack or something from surgical procedure, old age, whatever reason it
just quite working. SA node not working and they replace it with a man-made pacemaker.
Used for support after cardiac surgery. If they crack your chest open and go into the heart you will come out
with a temporary pacemaker. So they can increased CO or HR if needed.
Used as a diagnostic study. EP study – electrophysiology study. Looks at the electrical side of heart function.
Room in cath lab and they still go thru the groin. They can shock different places of the heart and see how it
reacts. Tries to get the heart to go into VT to see who the trouble maker is. When they find them they burn
them. They ablate the part of the heart that is making the electrical problem.
Pacemaker System – p. 858
A simple electrical circuit –composed of:
o Pulse generator – battery, what initiates the negative electrical current which is going to cause us to
depolarize.
o Pacing lead – wire that goes to the heart that carries the electricity there to cause the depolarization.
o 1, 2, or 3 electrodes that go to the heart – depends on what type of pacemaker it is.
Temporary pacemaker uses a 9 volt battery. Always have extra one at the bedside, at the very least in the unit.
Change every 24 hours to make sure it doesn’t run dead. Check hospital policy. Also have extra pulse
generator on the unit so if it malfunctions we have another one we can hook up quickly.
Long-term permanent pacemaker which is inside the skin and upper chest, they use a lithium battery. How
long it lasts depends on how often the patient uses it. 100% paced all the time will wear out sooner. Have to
go back to surgery to replace. Settings changes do not require surgery. They can lay something over the chest
and communicate with the pacemaker – called the “Power box”.
Pacing lead – what the negative electricity goes down. Don’t worry about bipolar and unipolar just know
that’s what carries the electricity from pacing generator to the heart. Where the electrodes are connected.
Pacing Routes: Permanent or Temporary
o Transcutaneous (Temporary)
Temporary because its going through skin
