This case is written by Dr. Kyla Caners. She is a staff emergency physician in Hamilton, Ontario and the Simulation Director of McMaster University’s FRCP-EM program. She is also one of the Editors-in-Chief here at EmSimCases.
Why it Matters
This case tackles several components of ICD management that can make emergency physicians a little nervous. Most notably, it highlights:
- The discomfort that staff members may have with touching a patient whose ICD is firing, and the need to reassure them of safety
- The role of a magnet in terminating the inappropriate or ineffective shocks delivered by an ICD
- The various anti-dysrhythmic options that are available to treat ventricular tachycardia (and the need to ask for expert opinion!)
- The way a sympathetic response or anxiety may exacerbate dysrhythmias
A 40-year-old male to presents to your tertiary care ED complaining that his ICD keeps firing. He keeps yelling “ow” and jumping/jerking every couple minutes during his triage. He has an ICD in place because he had previous myocarditis that left him with a poor EF.
A 40-year-old male presents to the ED complaining that his ICD keeps firing. He will have a HR of 180 and VT on the monitor. He will occasionally yell “ow.” The team will need to work through medical management of VT, while considering magnet placement for patient comfort. The patient will remain stable but will trigger VT with his agitation.
Download the case here: Stable VT with ICD firing
ECG for the case found here:
(ECG source: http://lifeinthefastlane.com/ecg-library/ventricular-tachycardia/)
CXR for the case found here:
(CXR source: https://commons.wikimedia.org/wiki/File:Implantable_cardioverter_defibrillator_chest_X-ray.jpg)