Page 208 - Critical Care Nursing Demystified

Chapter 4 CARE OF THE PATIENT WITH CRITICAL CARDIAC RHY THM DISTURBANCE NEEDS 193

TABLE 4–5 Cardiac Medications With Symptoms (Continued)
Rhythm Disturbance Treatment
Ventricular fibrillation Epinephrine
Vasopressin (one dose)
Amiodarone
Lidocaine
Asystole Epinephrine
Atropine

Special Cardiac Devices to Help Maintain the Patient’s Rhythm

Cardiac Pacemakers: Transcutaneous, Epicardial, Transvenous,

and Permanent Pacemakers

What Went Wrong?
6 Pacemakers (pacers) are electrical devices that help the heart’s electrical Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
conduction by artificially producing a spark that captures the heart when the
patient’s SA node fails or there is a block in conduction in the heart. They can
also be used to control very fast rhythms when medications are not effective
because they can control the heart from an electrical charge greater than the
heart can generate itself. So pacers are used for
• Heart block
• SA node dysfunction (sick sinus syndrome)
• Tachy rhythms (SVT, atrial fibrillation/flutter, VT)
• Cardiac arrest

• Open-Heart Surgery (OHS)
• Electrophysiological testing
All pacemakers include the following parts: generator box or power source,
means of delivery (wires or catheter), and lead wires. The generator box or
power source provides the power for the pacemaker and can be manipulated
to increase the strength of electricity applied to the heart. This is especially
helpful in fast rhythms where the generator box power overcomes the heart
and commands the heart (takes over as an external pacer). The more perma-
nent pacers have lithium batteries that must be replaced about every 6 years.