Pacemakers

Before I became an NP, I worked for a lot of years as a nurse in a cardiac surgical ICU. So, I became pretty acquainted with external pacemakers. Essentially, all the heart surgery patients came out with epicardial pacing wires attached to an external pacemaker. Because the CTICU I was working in was also the CCU, I got a fair amount of experience with transvenous pacemakers as well. But, unless you’ve worked in those specialized environments (and really just due to the volume, the CTICU is the place you really get to know these devices), you probably have a limited exposure to external pacing. At least outside of the transcutaneous pacing learned in ACLS.

Two great resources for you today on this topic (well, more really because one of these has some other really good links in it as well). Scott Weingart over at EMCrit just did a really great episode of his podcast dealing with transvenous pacemakers. He covers insertion – which is a really pretty specialized skill, but one that you should have if you practice in a setting where cardiology isn’t always readily available – as well as the box itself and some troubleshooting. The same principles (other than insertion, of course) apply to epicardial pacing if you should find yourself in a CTICU and need some help with this complex topic. He covers modes and sensitivity as well. He does a good job of explaining sensitivity, which is probably the most confusing part of pacemakers. The wall analogy that he uses is pretty similar to the “see over the fence” analogy that I use when I teach this concept, so I won’t belabor it here. He also mentions a great talk that Dr Sarah Wesley gives on the subject at the Bedside Critical Care conference. He links to it in his post, or you can go directly there.

Finally, a great new site that I just discovered, ICU One Pager, has a phenomenal resource on emergency pacing that covers everything you need to know on one page. Shown below, or you can download it as a PDF from their site.