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Barry Pacer AICD

Indications for Pacer/AICD persistent bradycardia not response to medication, AV block, Syncope, Sinus nodal dysfunction
What 1st letter means in classification of Pacer? Chamber paced
What 2nd letter means in classification of Pacer? Chamber sensed
What 3rd letter means in classification of Pacer? Response to sensing
What 4th letter means in classification of Pacer? Programmability
What 5th letter means in classification of Pacer? Anti-tachy function
What mode of pacers are most common? VVI and DDD DDD is the ultimate form of physiological pacing available today
How to prevent lead displacement? Avoid N2O because of the expansion of air trapped; if PA cath needed, use paceport swan
What 5 potential effect of electromagnetic interference (electrocautery( on pacers? 1. Inhibition of pacing 2. Reversion to asynchronous mode of pacing 3. Inappropriate reprogramming 4. Induction of A-fib/V-fib 5. Burns at lead-tissue interference
What 5 anesthetic considerations for patient with pacer? 1. Identify type of pacer 2. Ensure normal serum potassium 3. Increase EKG monitor's pacing detection to maximize visibility of pacer spikes 4. Possible A-line to assess pulsatile flow 5. Avoid Sux or defasiculate (may inhibit pacer function)
Pacer may mask toxicity of antiarrhythmic drugs, electrolyte disorders, MI? Yes
Any post op considerations? Yes, avoid shivering (inhibit pacer function) and have pacer interrogated and reprogramed.
Special equipment required in OR? and Why? Have MAGNET available! It converts a demand pacer to an asynchronous "fixed" pacing mode because pacing inhibited by electrocautery.
Intraoperatively, what precautions should be executed? 1. Ask surgeon to use bipolar cautery. 2. Place grounding pat as near to surgical field but as far from pacer as possible (>15 cms) 3. Ask surgeon to use only short bursts and lowest energy level possible.
If cautery causes asystole, what should we do? Have surgeon to stop bovie and place magnet over pacer.
Any precaution if pacer placed in asynchronous mode? Be aware of potential for v-fib (R on T phenomena)
What 1st letter means in AICD? Shock Chamber
What 2nd letter means in AICD? Antitachy Chamber
What 3rd letter means in AICD? Tachycardia Detection
What 4th letter means in AICD? Antibrady Pacing Chamber
ICD-S means? Shock only
ICD-B means? Shock + brady pacing
ICD-T means? Shock + brady pacing + tachycardia termination
What are 4 effects of electromagnetic interference on AICD? 1. Inappropriate countershocks (senses cautery as Vf) 2. Inappropriate overdrive pacing (senses cautery as VT or SVT) 3. Inappropriate suspension of arrhythmia detection 4. Permanent damage to pulse generator
Can Amiodarone be continued with AICD? Yes, but has potential complications when combined with anesthetic agents such as profound hypotension, bradycardia.
What function should remain active even with magnet in place? Antibrady function
What insertion sites be used for transvenous pacemaker? Right internal Jugular area, left subclavian and femoral vein
Created by: nancychau