Page 86 - Critical Care Notes

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CV
■ Obtain a 12-lead ECG.
■ Assess VS per hospital protocol. Assess peripheral pulses.
■ Assess LOC.
■ Administer antibiotics (cefazolin, vancomycin).
■ Assess dressing for bleeding, drainage, or signs of infection.
■ If epicardial wires present, clean site and cover wires per hospital policy.
■ Monitor CBC, BMP.
■ Administer oral pain medication as needed.
■ Patients with pacemakers may be defibrillated. Avoid placing the defibrilla-
tor paddles or pads closer than 5 inches from the pacemaker battery pack
or pulse generator.
■ Patient education is crucial: activity level, signs of pacemaker malfunction,
signs of infection, electrical safety precautions, medication usage. Provide
patient with identification card related to pacemaker. Consider telemonitor-
ing of these patients for compliance, pacemaker function, and avoidance of
complications.
Complications
■ Pacemaker malfunction:
■ Failure to discharge: Pacemaker fails to fire. Seen as patient’s HR
programmed rate
■ Failure to capture: Pacing stimulus not followed by depolarization of
atrium and/or ventricle
■ Oversensing: Pacemaker detects noncardiac electrical events (electro-
magnetic interference, large T waves) as depolarization
■ Undersensing: Pacemaker cannot sense patient’s intrinsic beats, with
resulting inappropriately placed pacemaker artifacts
■ Pneumothorax
■ Ventricular irritability
■ Perforation of ventricular wall or septum
■ Catheter or lead dislodgment
■ Infection
■ Hematoma
■ Abdominal twitching or hiccups
■ Pocket erosion
Automatic Implantable Cardioverter-Defibrillator
Device (AICD)
■ The AICD continuously monitors the patient’s heart rhythm, diagnoses any
rhythm changes, and treats life-threatening ventricular arrhythmias.
■ Main indications for use of an AICD relate to secondary prevention in
patients with prior sustained ventricular tachycardia (VT), ventricular fibril-
lation (VF), or resuscitated sudden cardiac death (SCD) thought to be
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