Wednesday, November 14, 2012

Using the Monitor (Lifepak 12)

So we learned how to use the Lifepak monitor today in class. We covered Lifepak 20, and somewhat of Lifepak 12. No matter what, the buttons are still the same on both monitors; same location, same style, everything is the same with the buttons. Monitors come in different phasic manors. A biphasic (two) monitor sends electrical impulses from both pads, into the heart. Where as the monophasic (single) defibrillator sends an electrical impulse form pad to the other pad, passing through the heart.

If you are unsure on your monitor, it is best to start shocking at 360 J.

So you have a patient that is in ASYSTOLE:
-Start CPR

So you have a patient that is in VFIB, VTACH without a pulse (defibrillator mode):
-Start CPR
-Turn on monitor
-Click the "charge" button and select your Joules
     -Monophasic ---- Initial shock is 360 J
     -Biphasic      ----- Initial shock is 200 J --> 300 J --> 360 J
-Charge defibrillator
-Shock the patient

So you have a patient who is bradycardic (Transcutaneous Pacing, TCP, mode):
-Turn on monitor
-Press the "pacer" button
-Press the "rate" button to increase the HR to which you want
    -Normally, start off with a HR of 60
-Press the "current" button
    -Start off with 10, and work you way up, normally you will hit around 100 until you get your affect
        -You want the "|" line, made by the monitor, to be followed by a QRS
    -Once you select the proper milliamps, increase it by 1, so you don't lose the QRS
-Leave monitor in place, reevaluate patient routinely

So you have a patient who is in VTACH or other TACH rhythms with a pulse (cardiovert mode):
-Turn on monitor
-Press the "SYNC" button
-Press the "energy select" button
     -Increase to 100 J
-Press the "charge button"
-Press, and hold, the "shock" button
     -You must hold this, because the monitor is trying to deliver the shock at the right time
           -During the R-wave
-If you need to cardiovert your patient again, MAKE SURE TO CLICK THE "SYNC" BUTTON FIRST
     -Most monitors will turn off the sync, so must turn it back on
           -You want the green light on the "sync" button to be flashing

So the sake of this post, we are going to have all of the limb leads on our patient, and assume that our patient is symptomatic. If the patient were a-symptomatic, we would: give oxygen, monitor, and in some cases medications. We will cover the a-symptomatic patient's in a later post.

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