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Wrong answer
- by Bostonstrong
- 2014-02-26 08:02:12
- General Posting
- 1073 views
- 17 comments
Talked to the preop nurse this am. Politely requested a rep for this party. She said don't worry, we just throw a magnet on it.
Politely informed her that switching DDDR mode to DOO mode means the pacemaker does not sense or inhibit, increasing the probability that an R wave can land on a T wave and precipitate VT/V fib. And that I prefer having a pulse. Silence. Then she said I will schedule a rep. Smart nurse! Thanks everyone who advised me on this.
17 Comments
I'm lost
by Duke999 - 2014-02-26 09:02:11
I have no idea what Bossy and Donr are talking about.
Bossy, what do you mean with R wave landing on T wave?
Sorry, I'm not that smart :-)
I wish you well.
Duke
Ok, I missed the first half
by Theknotguy - 2014-02-26 09:02:46
Got the punch line of the joke. I prefer a heart beat too, especially since I went a while without one. The CPR was OK especially since it saved my life. But the cracked rib, busted rib, and the collapsed lung were no fun.
So what is the surgery/procedure that precipitated this? If I go into a similar situation I want to be able to have the same conversation.
Theknotguy
Duke
by Bostonstrong - 2014-02-26 09:02:59
There is a great article, Pacemakers made incredibly simple for anesthesiologists by T Wallace. Google it, it explains it very clearly and much better than I could. When they throw a magnet on a pm in surgery it no longer senses or inhibits (DOO) so if your heart rate is faster than the paced rate one on your heart beats could land on the wrong part of a paced beat and cause a problem. The r and t waves are just different parts of a normal heart beat and resting phase. P wave is the beginning, the QRS, then T, repeat. Normally your pm inhibits or prevents this from happening, a magnet changes that.
Donr I'm sure you could explain this better!
Sounds like...
by Grateful Heart - 2014-02-26 10:02:02
you've encountered your 2nd challenge. Sorry to hear that, I thought it was only a trend on the East Coast.
Some extra reading material:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420917/
and
http://www.ncbi.nlm.nih.gov/pubmed/23757477
The first one just happens to have Dr. Oz as a co-author....maybe that'll move them.
I think what Don means is.....even if the preop Nurse was truly listening and planned on following through for you, the challenge and "power" rests with the rep when they show up and IF they show up.
Since you are an NP, I would suggest if you find a GOOD rep who is worth their salt......request him/ her each and every time you need one, especially for surgeries. Hopefully you should have some pull. I requested one in particular and he did not show up for the last procedure, hence the stress continued.
Grateful Heart
@knotguy
by Bostonstrong - 2014-02-26 10:02:06
preparing for a knee surgery and I want the anesthesiologists to be on top of this. They like to throw magnets on pms during surgery but Donr has educated me that this is not the optimal way to do things. So in true Bossy form I am telling the staff up front how to do their job. I'm also bringing them chocolate...
OK, read it three times
by Theknotguy - 2014-02-26 10:02:42
OK, read it three times. Got it.
So any surgery where they have you under requires a rep?
Question in my mind is why they'd just throw a magnet on it? Why not leave it as is?
Just the same, a great example of being your own advocate.
Theknotguy
@theknot to elaborate a bit on Bostonstrong
by boxxed - 2014-02-26 10:02:47
The EMI (electro-magnetic interference) from cautery can potentially be seen and interpreted by the PM as heart beats. So it could end up tracking the noise for a bit @ the Max Track Rate before the mode switch. Or it can inhibit.
The rationale with inhibit is, the PM is seeing the noise and thinks you're going at (random number) 200bpm even if you're going 30 without the pacemaker. If it thinks you're going 200bpm, the clock it uses to count beat to beat gets constantly reset and it won't ever pace. So if you're dependent you could be stuck in the 20-30's while the PM happily thinks you're @ 200bpm and don't need any help with bradycardia.
Now imagine that same scenario with an ICD, which is designed to start trying to treat rates @ 200bpm with ATP or High Voltage Therapy.
Oversimplified explanation
by Bostonstrong - 2014-02-26 10:02:59
The pm senses voltage from your own heartbeat. Electrical noise from OR instruments can be misinterpreted by the pm as your own heartbeat so they change the mode with a magnet so it doesn't sense or inhibit.
@bostonstrong
by boxxed - 2014-02-26 11:02:00
I sent you a PM that kinda elaborates on the industry side of these type of surgical device checks. Gives them their perspective. Not trying to justify them "no-showing" by any means. That's inexcusable.
boxxed
by Grateful Heart - 2014-02-26 11:02:40
Would you mind sending that to me too. I respect your knowledge and insight and would love to see what you have to say.
Thank you,
Grateful Heart
@gh
by Bostonstrong - 2014-02-26 11:02:55
I will read those articles, thanks! If the rep does not show up I will not hesitate to contact St Jude's, the hospital administrator, the director of nursing, or any of the hospital regulatory boards. HFAP and the state board of health are always interested in certain violations. Being in the industry so to speak I know where the jugular is. If they play nice they have no worries.
Perhaps the pm companies need some feedback and publicity about how they run things? I wonder if it was their mother/father/child/spouse in OR how willing they would be to throw a magnet on it?
I'm fairly new to all this but from what I can tell the ethics in this industry blows.
It's nerve wracking enough to need surgery again without worrying about professional competencies.
Ref my first comment .....
by donr - 2014-02-27 09:02:58
.....about trusting the Prep Nurse.
I really have difficulty explaining exactly what I mean w/o lapsing into language best understood by:
Marines
Airborne Soldiers
Ammo Humpers
Sailors when the coffee runs out
Commandos
The Black Gang aboard the Titanic
National Football League linemen facing one another during the Superbowl
It involves a subset of the English language that transcends international borders & even if not recognized in the various dialects we use, is immediately understood through context.
It can only be written for consumption by polite, genteel, mixed company by using the shift key & the top row of keys on a QWERTY keyboard - called "Grawlix.".
If I were to use it in the open post section, Blake would not only ban me for life, he would come down here & rip my Modem out of the wall, smash it with a sledge hammer, burn it & spread generous quantities of salt over it.
It would probably open me up to legal action for libel, slander, defamation of character, et al. But could be defended against using the truthfulness doctrine.
It concerns the reputation for veracity when it comes to promising something to patients who will soon be sound asleep & incapable of checking up on whether or not they come through on their promises. It also describes the character of such people, as sensed by many of us who pontificate in here. Even PMC Cyberfriends who I consider to be the epitome of the definition of "Lady" (in the generic sense, not in the honorary title sense, as in "Grand Dame Bossy")
Simply & succinctly put, it would read "Promise them the Moon, but give them the %$^$#$%%^!".
Any further clarification will have to be handled via Pvt Msg.
Donr
(Former Ammo Humper)
Snow
by Bostonstrong - 2014-02-27 12:02:42
I will be in California where they are getting the storm of the century Friday through Sunday. 65 Mph winds, torrential rain, flooding. Our hotel is oceanfront, hoping we don't need to evacuate. It's going to be an adventure but not great paragliding weather.
Excellent!
by Moner - 2014-02-27 12:02:51
Hi Boston,
I'm very proud of you for pushing back, when the nurse mentioned the magnet.
I find it completely mind boggling that as a health professional, they would try to pull this over on you.
Knowledge is POWER.
Glad to hear the rep will be by your side.
Moner
>^..^<
P.S. I really hope you don't get anymore snow this weekend, because that probably means, we'll be getting it 24 hours later.
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