References
Implantable cardioverterdefibrillators: a case report
Abstract
Implantable cardioverter-defibrillators (ICDs) are devices placed into patients with a variety of cardiac conditions to prevent sudden death from dysrhythmias. On occasion, these devices can malfunction, presenting a challenge to both prehospital and emergency department providers. In this article, we present a case in which pre-hospital providers encountered a patient whose ICD was firing continuously in a patient with sustained ventricular tachycardia. We then discuss the prehospital management of patients whose ICDs have fired. Scenarios discussed include management of the single appropriate ICD shock, management of multiple appropriate ICD shocks, and management of inappropriate ICD shocks.
An emergency call was placed to emergency medical services (EMS) requesting an ambulance for a patient whose implantable cardioverter-defibrillator (ICD) had fired. An advanced life support (ALS) unit arrived to find a 70-year-old male in no acute distress. The initial electrocardiogram (ECG) showed ventricular tachycardia (VT). The patient was then shocked by his ICD, which converted him back into a paced rhythm. The patient again went into VT and was shocked an additional four times by his ICD prior to the arrival of the transporting ambulance.
The ambulance crew found the patient awake and alert, and complaining only of chest pain from the ICD fring. Vital signs were as follows: heart rate 70 beats per minute and regular, blood pressure 118/80 mmHg, respiratory rate 16 breaths per minute, and pulse oximetry 99% on room air. The patient's 12-lead ECG showed a paced rhythm. The patient had a past medical history of coronary artery disease, hypertension, high cholesterol, and congestive heart failure. His surgical history included coronary artery bypass grafting and multiple cardiac stents. His medication list included clopidogrel, furosemide, amiodarone, simvastatin, and carvediol. The patient was transported to the emergency department without need for further intervention.
Subscribe to get full access to the Journal of Paramedic Practice
Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.
What's included
-
CPD Focus
-
Develop your career
-
Stay informed