Blood cultures: (+) in 20-25% of patients (commonly S.Signs/Symptoms: warmth, swelling, erythema, pain, fever.It may reflect adequate native conduction. Absence of paced complexes in a patient with a pacemaker does not always indicate pacemaker dysfunction.Atrial spike conducted through AV node and generates QRS.Conducted from intrinsic atrial activity.Second spike results in ventricular depolarization First spike results in atrial depolarization.Two narrow “spikes” seen representing an atrial stimulus (1st spike) and ventricular stimulus (2nd spike).Note: RBBB formation signifies lead displacement.Narrow “spike” represents pacemaker generated electrical stimulus.EKG appearance depends on type of pacemaker in use.Dual lead: endocardial lead positioned in contact with right atrium and ventricle.Single lead: endocardial lead positioned in contact with right ventricle.Power decreases gradually with lithium battery not abrupt cessation of activity.Battery duration: 4-10 years (depends on features of device).Houses power source (almost always lithium battery).Chronic bifascicular or trifascicular block with intermittent 3rd degree or 2nd degree AV block.Symptomatic bradycardia resulting from 2nd degree AV block.Symptomatic bradycardia secondary to necessary drugs for dysrhythmia management.Ventricular dysrhythmia resulting from block.3rd degree or advanced 2nd degree (Mobitz II) AV block with any of the following.A ventricular event outside the refractory period will be inhibitedĬommon Indications for Permanent Pacemaker Placement.Device has a single lead in the ventricle that senses ventricular activity and can pace the ventricle.Sensory response: Can inhibit pacemaker in response to an intrinsic ventricular depolarization or trigger in response to an atrial intrinsic depolarization without a ventricular response.Chamber sensed: Intrinsic depolarization of the atrium and ventricle is sensed. Chamber paced: Atrium and ventricle can be paced.None (O): Does not trigger or inhibit regardless of the native activity.Dual (D): Dual inhibition of both atrial and ventricular pacing in response to intrinsic ventricular depolarization.Inhibited (I): Sensed intrinsic depolarization will result in inhibition of the pacemaker.Triggered (T): Sensed intrinsic depolarization will result in the pacemaker discharging (this setting not used in current generation pacemakers).First three letters are most useful in ED management.Five letter code system that describes the different pacemaker settings.Have you ever been confused by the alphabet soup of pacemakers? This post will serve as a pacemaker basics reference.
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