EMS is called to the residence of a 71 year old male for “seizures.”
On arrival the patient’s spouse meets the ambulance outside and hurries the paramedics along saying “Come quickly! Please help him!”
The paramedics arrive at the patient’s side just in time to see him receive an ICD shock.
They ask how long this had been going on.
“That was my 15th shock!”
The patient states that he “felt himself going faint” just prior to the first shock.
The cardiac monitor is attached and the following rhythm strips are recorded.
Numerous skin tears are noted to the patient’s arms which the spouse states are related to convulsions induced by the ICD shocks.
Vital signs are assessed.
- RR: 20
- HR: 60
- NIBP: 108/72
- SpO2: 98% on room air
Past medical history:
The EMS crew learns that this patient survived two sudden cardiac arrests prior to receiving his first ICD in 1992. The device was replaced in 2008. The patient does not have his device ID card but knows that it was made by St. Jude Medical.
The patient states he takes several medications but he can only remember one of them: Coumadin.
The EMS crew contacts Online Medical Control and receives permission to apply a ring magnet to the device. The magnet is applied and taped in place. The tape doesn’t hold and a FF is assigned to hold the magnet over the device.
A 12-lead ECG is obtained.
A bigeminal rhythm is noted on the monitor.
The patient is loaded for transport.
IV access is achieved.
En route the the hospital serial 12-lead ECGs are obtained.
Vital signs are re-assessed.
- RR: 18
- HR: 76
- NIBP: 102/70
- SpO2: 99% on room air
The patient feels much calmer and says, “Please don’t let that thing shock me again.”
A final 12-lead ECG is captured on arrival at the hospital.
What do you think the patient would say was the most important thing the EMS crew did for him?
For a full discussion of inappropriate or ineffective ICD shocks, including when and how to apply a ring magnet, see the following links.