❗️❗️CORRECTION: ❗️❗️I apologize as I flipped the terminology for sensitivity! The higher the mV, and thus the higher the "fence", the LESS sensitive we are and the LESS chance we will see the rhythm. As we lower the mV thus lowering the "fence" we become more sensitive to the underlying rhythm and have a better chance of seeing it. If we go too low, then we become TOO sensitive and would see all electrical activity as a heartbeat instead of just, for example, the peak of the QRS complex. Hence our threshold is the least sensitive setting (highest mV) to just barely begin to see the underlying rhythm. In the next lesson on troubleshooting, I will correct this and make sure to explain this better. Sorry for any confusion! 😔
Thank you Eddie Watson for your instructional videos. It has definitely helped me learned complex topics in my ICU residency as a new grad. Please keep making new videos. It was a shock to know that you were a grunt. Semper fi.
I'm very thankful for this lesson. I've gone into lots of articles but I've never grasped the concepts like i did with your help. Keep up the good work! Greetings from Mexico City.
I absolutely admire your videos. I am a medical student from Germany preparing for my last Board exams. Every textbook I have ever read has always been delivering theoretical knowledge. However, the examinations always expect APPLIED knowledge and understanding the exact steps. Your stuff has been an enormous help
So awesome to hear this! I've happy to hear my videos have been helpful for you and congrats on reaching this point. That's amazing work. Wishing you all the best!
I don't know how I missed this comment. So great to hear that this videos was able to help make sense of this topic for you. Truly happy to be able to help!
Another amazing video Eddie. Just started as new grad on days in mixed ICU that gets post-op CABG. Like others have mentioned, we would love more vids on that topic. Thanks for all your great work and hello from San Francisco!
Thank you! I'm going to better explain sensitivity in the "Troubleshooting" video coming next week. I flipped the terminology as higher mV is less sensitive.
I hated that thing after my surgery and the nurses messing with the settings then telling each other to put it back to a previous setting. Then asking me 'you could feel that?'. UM YES!
This video was really helpful. I am confused at the 3nd with the sensitivity,threshold,sensing. It would be helpful to see the buttons you are. Talking about with demonstration and examples to better understand. Thank you
Your video is awesome!! Superbly well explained. Its concise dans straight to the point! Im a "Old" 24 years ER nurse and been a paramedic for 11 years.
Thank you! Really happy to hear this. Sometimes I feel like I drone on but also really trying to make the points that need to be made so I'm glad to hear you enjoyed it
At minute 27:35 you said we want to set the mA output at 2-3 times of the threshold we just figured out. But in a previous video about temporary pacing (I believe in The Shocking Truth) you said to set it to 10% above that threshold. Which one is correct? Thanks in advance, and I chime in, your videos help me learn in a way that textbooks cannot, and they can be played in the car while driving (and watching the road, not the video), inundating me with the knowledge I need as an ICU nurse.
The output settings on a defibrillator vs pacing box are vastly different. The outputs have a much wider range on the pacer box but at much less mA than the defibrillator, so we have different parameters for setting these limits. Hope that makes sense.
New grad RN here about to start working on the floor with my preceptor next week.. you help ease my anxiety and improve my confidence in my knowledge. Thank you so much!
There's actually a mode called DVI in our pacemakers that I didn't see listed here.Btw our patients (in the cardiac surgery ICU) all come out with 2 wires not just one.But as I understood from the doctors, one is just the "body" and the other one actually delivers and senses.That wire usually comes with a noch on it.
I'm still having a hard time with DDI at 19:52. How does it prevent high ventricular rates in afib? The heart has erratic atrial activity that propagates to the ventricles -- and if the pacemaker is sensing all those ventricular beats, wouldn't the pacemaker just decide not to pace? Having a difficult time conceptually applying the nomenclature with afib and pacing. Thanks again for the video as always
Great question Kyle. So remember that the "I" means that it is going to inhibit. Therefore, it is not going to pass the sensed beat on to the ventricle from the atrium. Now, I think what you are getting at is if they have an intact AV node pathway. In that case, the atrial activity will naturally make it to the ventricles and there is not much we can do about it. You are correct that in this situation, the pacemaker would sense all these beats and just not fire. But, in the case of AV pacing, we typically will do this when the AV nodal pathway is not intact or compromised. The ventricle is relying on our pacemaker sensing the atria beat, to then tell it to fire via a pulse. Hope that makes sense?
I went in last Thursday for an ablation surgery for AFib. While doing the procedure I went into a 3rd degree heart block and the team immediately went into life saving mode. Airway and placing one of these external pacemaker in my femoral vein until my permanent pacemaker was placed next day. Thank goodness for this technology or I wouldn't be here typing this.
Well I defiantly messed this one up. The higher the mV setting the LESS sensitive. The higher the mV, the higher the fence, hence less likely to see the underlying rhythm making it LESS sensitive... sorry for the confusion. You would be correct that the threshold is the highest mV setting to still see the underlying rhythm, but this would be the minimum sensitivity to see it. If the "fence" is lowered, it becomes more and more sensitive and eventually too sensitive and detects too much as the intrinsic HR, instead of just the peak of, for example the QRS complex. Sorry for the confusion. I certainly messed it up here hence the confusion. I will better explain this in the next lesson where I go over troubleshooting.
@@misterlogik8163Bradycardia is the low heart beat when your heart beat less than 50 then it's called Bradycardia and when your heart beat above 100 that called tachycardia
@@rogervanbommel1086 In order to get the writing to line up perfectly with my talking I have to edit and speed up the writing. Saves people from watching me just write.
Fantastic tutorial, really well explained with great examples thank you. The asynchronous modes are used for example in cardiac surgery when you want to pace and you have a lot of other activity going on during an operation such as diathermy / handling of the heart, when you don't want the pacemaker to sense everything but still want to pace.
