Patients with Internal Pacemakers

[Guest guest]

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@...