tag:blogger.com,1999:blog-18943510.post4954184946366285620..comments2023-08-21T02:57:37.362-05:00Comments on Dr. Wes: EKG Du Jour #16: Pacer, Pacer EverywhereDrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-18943510.post-17976236876595903412009-06-15T17:50:27.270-05:002009-06-15T17:50:27.270-05:00I was at least right when I said they needed a set...I was at least right when I said they needed a setting tweak and didn't need to go to the Unit!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-6304530736394411192009-06-15T09:33:45.058-05:002009-06-15T09:33:45.058-05:00Anony 10:46-
Yes.Anony 10:46-<br /><br />Yes.DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-62471757079322095702009-06-14T22:46:27.932-05:002009-06-14T22:46:27.932-05:00Dr. Wes:
Is the V-V timing zero then for this bi-...Dr. Wes:<br /><br />Is the V-V timing zero then for this bi-V pacemaker?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-59042179917178379912009-06-13T10:24:23.198-05:002009-06-13T10:24:23.198-05:00To understand this tracing, it is best to look to ...To understand this tracing, it is best to look to the end of the strip where dual-chamber pacing is seen. This defines the lower rate of the pacemaker (60 b/min) and the AV delay (slightly over 120 msec->actually 130 msec). Note there is an atrial response to the pacing output here (last two arrows on the “clue” tracing). <br /><br />What is puzzling is the QRS morphology difference of mostDrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-46191139041837676972009-06-12T18:33:04.553-05:002009-06-12T18:33:04.553-05:00Are you EVER going to get around to filling us in ...Are you EVER going to get around to filling us in on this one????<br /><br />I agree with Anonymous #1 (pacer geek). Probably from industry. Way too smart to be a doctor.Jayhttps://www.blogger.com/profile/10897176780069403370noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-43757816099044722722009-06-12T08:43:40.569-05:002009-06-12T08:43:40.569-05:00accelerated junctional rhythm.
all good....just...accelerated junctional rhythm. <br /><br />all good....just let him wake up a little bit more, monitor him and stay put as long as everything else stays copacetic.<br /><br />SKAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-8829532827862418902009-06-11T07:27:55.183-05:002009-06-11T07:27:55.183-05:00All right -
In light of the clue, I'll amend...All right - <br /><br />In light of the clue, I'll amend my answer and say atrial undersensing with occasional triggered activity.<br /><br />In other words, I'm with the pacer geek (and aspire to be one)! <br /><br />:)<br /><br />TomTom Bhttps://www.blogger.com/profile/18291404904437933272noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-37089287967030345582009-06-10T17:52:47.136-05:002009-06-10T17:52:47.136-05:00Good ideas.
Let me offer a little clue that might...Good ideas.<br /><br />Let me offer a little <a href="http://www.medtees.com/blog/EKG16a.jpg" rel="nofollow">clue</a> that might direct the thinking. (By the way, I hate faxed monitor strips, too).DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-35405134574202726122009-06-10T08:23:01.579-05:002009-06-10T08:23:01.579-05:00Dr. Wes -
My guess is that the pacemaker is func...Dr. Wes - <br /><br />My guess is that the pacemaker is functioning in DVI or DOO mode. Maybe the apparent shorter AV intervals can be explained by bivent pacing rather than AV timing.<br /><br />I would think a transfer to ICU would be made based on the patient's clinical status and not the behavior of the device (treat the patient, not the monitor).<br /><br />You're one of the few Tom Bhttps://www.blogger.com/profile/18291404904437933272noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-47746253496592419492009-06-09T20:39:29.976-05:002009-06-09T20:39:29.976-05:00Oh forgot to mention.....if the patient is hemodyn...Oh forgot to mention.....if the patient is hemodynamically stable there really isn't really any reason to transfer the patient solely based on this pseudomalfunction.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-71004333850768154772009-06-09T20:35:42.055-05:002009-06-09T20:35:42.055-05:00OK Wes I'll take a stab at this one. Whatever ...OK Wes I'll take a stab at this one. Whatever the disturbance is here resolves with the last 4 intervals on the 4th strip where you have DDD pacing with atrial and ventricular capture, I'll say a paced AV delay of approx 150ms. Prior to that there is a consistent narrow complex rhythm which is holding at a rate 0f 58-62 BPM. Not every complex receives an atrial or ventricular pace impulseAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-63624810539300020352009-06-09T18:09:05.831-05:002009-06-09T18:09:05.831-05:00My best guess is that somehow the cautery from the...My best guess is that somehow the cautery from the total hip caused the pacer to swap modes due to interference. It kind of looks like it is running in a AAO/VVO mode, in other words, asynchronously, but I'm not 100% sure on that due to the lack of pacing He doesn't need the ICU, just a pacer check to start. It's either that or the battery needs to be changed.Anonymousnoreply@blogger.com