Re: Patients with Internal Pacemakers

January 5, 2012

Mr. Gandy,

I can more than likely find out some information about the pacemaker on the

patient that I recently transported, but probably not from the patient 8+ years

ago.

I will see what I can find out, and try to keep everyone updated.

Marcus

January 6, 2012

Could it be the quality of the driving?

ck

In a message dated 01/05/12 11:48:51 Central Standard Time, mdfinney@...

writes:

I have a question for the group about paced patients, have you ever

witnessed or heard of this?

I have had 2 occurrences in my career that while transporting a patient

that has an internal pacemaker where the paced rhythm increases greatly while

transporting the patient in an ambulance at highway speeds.

Incident #1 occurred about 8 years ago while transporting a patient from a

rural hospital to the Medical Center in Houston. When the patient was

picked up at the hospital the patient's internal pacer was working and

perfusing at a rate of 70 beats per minute. The patient was loaded and

proceeded

to to transport to Houston. While on the way I noticed that the patient's

heart rate was fluctuating with the speed that the engine was turing, the

faster the RPM's on the engine that faster the pacemaker would perfuse the

patient. During that transport my partner advised that the battery light

had come one the truck. All unnecessary electrical equipment was shut off to

conserve energy knowing that the alternator was having problems. The

fastest that the patient's heart rate sustained was 160 bpm paced rhythm and

confirmed with radial pulses. The patient did not become symptomatic or

express any concerns about the increase in heart rate. The patient was

totally unaware of the

condition. No change in blood pressure or pulse oximetry. Once we

arrived to Houston the patient's paced heart rate returned to 70 bpm and

remained

there until we turned the patient over to the staff. At this time I

thought is was due to the alternator failure until a week ago when I witnessed

this same thing again.

Incident #2 occurred this past week while transporting a patient about 15

miles from his residence to the hospital. The patient also had an internal

pacemaker that was pacing a perfusion appropriately at 80 bpm. The

patient was loaded and transported to the hospital and while transporting the

heart rate increased to a paced rhythm and was perfusing with a radial pulse

at 140 bpm. This was while on the freeway driving a 70mph. As with the

patient before this patient was unaware of the increase in heart rate and

non-symptomatic. Once we arrived into town and the speed of the truck slowed

the heart rate slowed to 90 to 100 bpm. Once at the hospital and the

patient was removed from the ambulance to the ER the patient's paced heart rate

returned to 80 bpm. Side note this ambulance in only a few months old and

did not nor has it had alternator problems since this patient was

transported.

I have noticed a slight increase in paced rhythms while transporting

patient with internal pacemakers and not really thought much about it. Now

that

I know that it was probably not related to the alternator failure, are we

causing this phenomenon by transporting our paced patient's in ambulances.

Another thought being that since neither of these patient's were aware

that it was going on, does this same thing happen while they are driving or

riding in their own cars.

Interested in seeing what everyone has to say about this.

Marcus Finney, LP

mdfinney@...

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January 6, 2012