A Conversation for Pacemakers

Peer Review : A55979211 - Pacemakers

Post 1

Bookmouse

Entry: Pacemakers - A55979211
Author: Bookmouse - U2218784

Please could you have a look at this entry about pacemakers.

Thanks,

Bookmouse


A55979211 - Pacemakers

Post 2

Z

Hi Bookmouse. Lovely entry.. You've only covered permanent pacing though.

There's also 'external pacing' which is done in an emergency by placing electrodes on the skin. This is life saving at times, but really really uncomfortable, so you usually need to use an infusion of a sedative to stop your patient ripping it off.

There's also 'temporary pacing' which is done in an emergency, this is where the pacing wires are implanted in the normal way, but left attached to a box by the side of the bed.

(The thought of both of them brings out hot sweats in me)

Another important type of pacemaking is an Implantable defibrillator, which is usually combined with a pacing device, it's the same size and shape as a pacemaker but it's also a defibrillator.

Is it worth mentioning that they have to be removed before cremation otherwise the crematorium equipment can blow up?

Or that there are 4 types of heart block, and only 2 need a permanent pacemaker.


A55979211 - Pacemakers

Post 3

Lanzababy - Guide Editor

Hi Bookmouse!

Thank you for submitting this great entry to Peer Review. I have to admit that I am glad we have the great Dr Zen here to read and review.

I am going to re-read this tomorrow - smiley - book over a cup of coffee.

smiley - ok

Lanzababy


A55979211 - Pacemakers

Post 4

Emmily ~ Roses are red, Peas are green, My face is a laugh, But yours is a scream

Hi Bookmouse, nice informative Entry smiley - smiley

You do have the option of changing the title to 'Permanent Pacemakers' thereby avioding having to include every type of pacemaker in your Entry. The choice is yours. smiley - oksmiley - smiley

Emmily
smiley - cracker


A55979211 - Pacemakers

Post 5

Z

I'd be happy to write a bout temporary and external pacing if you want - I reckon it wouldn't need more than a paragraph. We used to use a lot of them, but now we try and hang on until we get a permanent pacer in.


A55979211 - Pacemakers

Post 6

anne-o-mally

Hi Bookmouse,

Great article, it makes a difficult subject much easier to understandsmiley - cool.

At work, I deal with the temporary pacing every day, but some people then do go on to need permanent pacemakers inserted. Some of the next info may be a bit out of date, because I haven't dealt with this for a long time (a good thing) but Dr Zen can help put me right if so. (Sorry Dr Zen, but you're much more knowledgable on this than mesmiley - blush)

In 'After the procedure' section, it might be worth mentioning that immediately post op (& usually for a few hours), they are advised to keep their left arm as still as possible, make no sudden movements with it & not to put their hands above their head. This to help make sure the implanted electrodes are not displaced. The same applies to touching the site - should be avoided, & may also be an infection risk.

Sometimes a small redi-vac drain is needed at the insertion site. It looks like a small plastic concertina & works by suction - so it will expand as any fluid/blood is drained from around the site. Normally it is stitched in & removed the following day.

In 'Living with a pacemaker' section, perhaps a short list of general 'do's & dont's' may be helpful?
For example - Carry a card with info about the pacemaker with you (not advised to go through airport security scanners, so you can bypass this if you have the info handy). Most everyday appliances in the home will not have an effect (ie microwaves). Surprisingly head/earphones can carry a small magnetic charge & so it's advised to keep them at least a couple of inches away from the pacemaker site.

Hope some of the above was useful, & smiley - goodluck with thissmiley - biggrin




A55979211 - Pacemakers

Post 7

Z

OOoh where do you work?

I have to admit I really struggled to get competent at temporary pacing, us general physicians are very rarely called on to insert temporary wires, as all the cardiologists tend to do it. The last time I needed one I had to call the consultant.


(I say I - of course it was the patient who needed it)


A55979211 - Pacemakers

Post 8

anne-o-mally

Oops, smiley - sorry. I left out a crucial word in my previous postsmiley - blush - I deal with Temporary *Epicardial* pacing every day. You'll guess from that.

Last time I dealt with the temporary pacing you mean, I was a very twitchy bunny indeed. That was scary but it ended wellsmiley - ok


A55979211 - Pacemakers

Post 9

Bookmouse

Hi all, thanks for the comments.Will make changes when I can - probably not until the new year. Dr Zen, I would be very happy if you would write a paragraph or so about temporary and external pacing, thanks. Hope you are all having a good Christmas.


A55979211 - Pacemakers

Post 10

AlexAshman


Good work smiley - ok

You ought to mention a few things just briefly:

- External pacing.
- DC cardioversion.
- Implantable cardioverter-defibrillators (ICDs).
- The fact that pacemakers explode if cremated, thus leading to the requirement to state that a patient does not have one if they are to be cremated.

Alex smiley - smiley


A55979211 - Pacemakers

Post 11

Lanzababy - Guide Editor

Nudging this one to the top of the pile smiley - smiley Hope you find a bit of time to come back and finish this off

Lanzababy smiley - elf


A55979211 - Pacemakers

Post 12

Z

I should write my bit on this one.. I'll see how busy I am at work tonight.


A55979211 - Pacemakers

Post 13

Bookmouse

Thanks, all. Sorry I haven't been here for a while! Will add things as suggested soon, subject to me being able to find out about them!


A55979211 - Pacemakers

Post 14

Bookmouse

Hi all. I've added the bits about not moving the arm and about the possible effects of magnetic equipment. I've also added a short bit about ICDs and cardioversion - is this enough? I haven't written about external pacing - thought I should leave that for Dr Z as he knows about it and I don't! Also added the bit about cremation.


A55979211 - Pacemakers

Post 15

Z

Temporary Pacing

In an emergency, usually after a heart attack the body may suddenly lose the ability to regulate the heart rhythm and this could cause serious problems as the heart can't beat fast enough to maintain a blood pressure.

The first opition is to use an Temporary External Pacemaker, this is usually a function on the more expensive defibrillators. There are two pads which are attached to the patient, these deliver an electric shock through the patient to the heart.

The big disadvantage is that a big enough shock to get all the way through the chest wall to the heart is actually rather painful and it happens 60 times a minute, so usually the patient has to be sedated. The other problem is that it's not always totally effective.

The next step in this sort of emergency is to put a Temporary Internal Pacing Wire in. Firstly you have to put a cannula in either the carotid vein, in the neck, or the subclavain, under the clavical, or the femoral, which is in the groin. You then thread a wire down the cannula and take an X ray to see where it is, once it's in the heart you can plug the wire into the pacing box.

The whole thing takes place in an X ray room, so you can always see where the wires are.


A55979211 - Pacemakers

Post 16

AlexAshman


"I've also added a short bit about ICDs and cardioversion - is this enough?"

Yep, that's great smiley - ok


A55979211 - Pacemakers

Post 17

Lanzababy - Guide Editor

Nudge - hope you find time to add the Temporary Pacemaking paragraph Bookmouse.


smiley - cappuccino


A55979211 - Pacemakers

Post 18

BMT

This is an excellent piece of work, hope bookmouse comes back soon to finish the odd bits that are left to do. smiley - smiley


smiley - cat


A55979211 - Pacemakers

Post 19

Lanzababy - Guide Editor

Yes, so do I. *taps fingers on desktop" - smiley - lurk


A55979211 - Pacemakers

Post 20

Bookmouse

Hi, sorry, but I didn't think I was adding the bit about temporary pacing - I thought Dr Z was doing it. If he's not, I will do it, but I really don't know anything about it. I can do it anyway and you can see what you think.


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