Temporary Pacemakers - Modes and Basic Settings

We continue the series on Temporary Pacemakers and take a look at the different modes they operate in and how to understand the nomenclature for representing that mode. That is further divided up in to differences between single and dual chamber pacemakers. From there we talk about the basic settings that are a need to know group. Having the knowledge of the modes and these settings will really strengthen your ability to care for patients with these devices.
❗️❗️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 less sensitive setting (highest mV) to just barely begin to see the underlying rhythm.
In the last lesson on troubleshooting, I will correct this and make sure to explain this better. Sorry for any confusion! 😔
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0:00 Intro
1:19 Modes
7:50 Single Chamber
15:17 Dual Chamber
22:24 Basic Settings
30:34 Conclusion
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#ICUAdvantage #Pacemaker #Nursing

[@ICUAdvantage]

❗️❗️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! 😔

[@sheejachacko975]

U

[@biomedicalequipments203]

👍🏻

[@hannahprice6212]

i was about to ask about 30:20 haha

[@chamoundong8200]

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.

[@andreawong5225]

You explain it so well. More than 'like', love it. Thank you so much,Eddie. Keep it up.

[@twinklelight1362]

Omg, I understand the very complicated concepts of modes and settings thanks to your very detailed and very clear explanation! 👏👏👏❤️

[@ICUAdvantage]

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!

[@krankguy11]

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.

[@ICUAdvantage]

Awesome! Really glad to hear this Diego. It doesn't always come easy, but once it clicks, it makes so much more sense!

[@WiamKhader]

best explaination i had so far about this topics. Thanks

[@goharali2162]

We love your lectures and the way you explain everything

[@ICUAdvantage]

Awesome to hear!

[@neethumekkalathdevasia2758]

Highly informative, good job, you're simply explained the more complicated modes of temporary pacing

[@ICUAdvantage]

Glad to hear the lesson was received so well!

[@larobey7961]

I'm new to CCU and I had a patient with a temp pacer. This helps me to understand so much.

[@ICUAdvantage]

Awesome! This is my whole goal with these videos! 😊

[@nastiaa5502]

I wish my attendings and professors could explain these as clear as you do Good job man God bless you for this channel

[@ICUAdvantage]

Really glad to hear you are enjoying the channel! My pleasure to be able to help.

[@arseniypetrov5857]

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

[@ICUAdvantage]

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!

[@Angelusloco15]

Amazing! Very well explained Sir! Thank you!!!

[@ICUAdvantage]

Yay! Thank you and glad you liked it!

[@rma3899]

Thank you for the amazing job. Highly informative

[@ICUAdvantage]

Thank you!!! 😊

[@cristinavasta8014]

Thank you Eddie. Your videos are amazing!

[@ICUAdvantage]

You are very welcome! Happy to be able to help

[@alexisdinerosvillegasbsnrn6030]

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!

[@ICUAdvantage]

So happy to read this Alexis! Congrats on the new position by the way and happy to know I've been able to help in some way!

[@judypeng4748]

I am a nursing student now taking critical care class. Thank you for your amazing videos lol!

[@ICUAdvantage]

Best of luck to you Judy. Almost there! Glad you liked the videos.

[@gregsellin]

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!

[@rogervanbommel1086]

Really nice new intro, great job, love your videos, very easy to understand but not too oversimplified

[@ICUAdvantage]

Thank you Roger. I'm really glad to hear this. Also glad to hear you like the new intro. I just love it!

[@annnguyen504]

Can you do videos about taking care post op open heart surgery patient such as CABG, valve replacement?

[@ICUAdvantage]

Yes! I do have both on my todo list!

[@eduardodiaz9354]

@@ICUAdvantage Still waiting for those videos

[@feibanh7057]

I’m also waiting for this lesson. 😊

[@ditzywallflwr9714]

Me too

[@mamtabegum6145]

Me too

[@dimahjar]

Thanks! very helpful 🙏🏻

[@goharali2162]

Very informative. Thanks a lot!

[@ICUAdvantage]

You are welcome!

[@mgvillacin2636]

A big thank you to you also ❤

[@patriciatenner6911]

Great lesson! Will definitely share.

[@ICUAdvantage]

Thank you so much Patricia!

[@lufefesomkala484]

Thank so much Eddie for this lesson

[@ICUAdvantage]

You are very welcome. Glad you liked it!

[@sarahleos8038]

YOU MADE THIS MAKE SENSE!!!

[@ICUAdvantage]

YYAAASSS!!! :)

[@karendenis-hayes9804]

This was very helpful! Thank you!

[@ICUAdvantage]

Happy to hear!

[@etherealeric8889]

Thanks for your help

[@ICUAdvantage]

You're welcome!

[@SarasMane]

This is just so well explained. Thank you!

[@rajthapa1997]

Thank you

[@mpeep03]

Thanks!

[@Tamara-kt6bt]

Thank you very much .

[@ICUAdvantage]

You are welcome!

[@xx_thor_user_xx6326]

Ecg graph at time 21.00 was super helpful!!

[@ninetales89]

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.

[@ICUAdvantage]

Yes! Thank you so much for sharing!

[@kiks0412]

thank you very informative

[@ICUAdvantage]

My pleasure

[@user-nq8hz7hx5y]

Thx! I pleased with your presentation as usually. I've struggled with mV and sensitivity as you said. I thought "i don't understand there smth" 😅

[@ICUAdvantage]

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.

[@hashemidris2877]

Great explanation

[@ICUAdvantage]

Thank you!

[@theresafrancis9096]

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

[@barshabaram6275]

Woww, you are just awesome, hats off to you 😇😇

[@ICUAdvantage]

You are too kind. Thank you!

[@arvinkaru8460]

Great tutorial

[@ICUAdvantage]

Thank you!

[@MACARIO813GAMER]

¡Gracias!

[@ICUAdvantage]

Muchos gracias Alan!

[@Spotlight.77]

Great 👌

[@ICUAdvantage]

Thanks 😊

[@manalalothman5415]

Thank you for your amazing video But I have confusing about meaning of trigger mode what does it mean Is it the same asynchronous?

[@irishrose7053]

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.

[@wijedasabadraperera1953]

thank you

[@ICUAdvantage]

You're welcome!

[@Tausendmedmarketing]

Great video- have you produced any instructions for rapid pacing during TAVR?

[@mirandaalexis]

helpful to my little ER nurse self

[@ICUAdvantage]

Yes, definitely useful there!

[@philippw.3145]

Danke!

[@ICUAdvantage]

Thank you so much for this Philipp!

[@user-hy1qr2jo9k]

Thanks

[@ICUAdvantage]

Welcome

[@76TomD]

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!

[@byebye5907]

Hi! Can you use AAI when a patient has a sick sinus syndrome?

[@cvanvolk1]

Can you show making the changes in the temporary pacemaker?

[@PREDATOR0140]

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.

[@ICUAdvantage]

Interesting. Thats on temporary pacers? I've never seen it. I tried looking up info on it, but not a ton of stuff out there.

[@PREDATOR0140]

@@ICUAdvantage yes.Temporary ones.I found info about it on this site : link.springer.com/chapter/10.1007/978-3-642-72367-4_67

[@padoomama]

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.

[@ICUAdvantage]

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.

[@kyleserafico380]

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

[@ICUAdvantage]

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?

[@kyleserafico380]

@@ICUAdvantage Thanks!

[@kevinzhuang448]

Great lecture, but I am lost in the last part 😢

[@survivingmedicine1838]

Thank you so much for these videos. They are really helpful. Can you please tell me what software do you use to make these videos?!

[@survivingmedicine1838]

That blackboard, how do you write at it?!

[@ICUAdvantage]

Its simple. Just Adobe Photoshop screencast to my iPad to write with the Apple Pencil. 😊

[@pinkypinky9982]

Is lecture notes available??for temporary pacemaker

[@ICUAdvantage]

Yes to members

[@rogervanbommel1086]

29:22 should it not be max milivolt setting -> detect heartbeat, you said that higher means less sensitive

[@ICUAdvantage]

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.

[@wholeNwon]

@@ICUAdvantage I don't think you are really a "defiant" person.

[@misterlogik8163]

Can a pacemaker do the job of regulating heart beat or at least overall improve the heart after Myocardial infarction???

[@ICUAdvantage]

Great question. Its actually preferred for bradycardia post MI

[@misterlogik8163]

@@ICUAdvantage Thanks for reply but what is bradycardia?

[@soyebsekh1897]

​@@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

[@yortizful]

Please add arterial lines to the list

[@ICUAdvantage]

Yes! It's on the todo list! 😊

[@rogervanbommel1086]

14:35, that looks like a audio/video glitch to me

[@ICUAdvantage]

Ugh, I think its an editing glitch... 🤦🏻‍♂️

[@rogervanbommel1086]

Did not think you did a lot of editing, not to criticize, it all looks like one continuous clip

[@ICUAdvantage]

@@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.

[@karendavis-bo9dy]

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[@karendavis-bo9dy]

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[@karendavis-bo9dy]

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[@maiyaniroshan4763]

Thanks!

[@ICUAdvantage]

Thank you so much for this Maiyani!

[@boyunkim9409]

Thanks!

[@ICUAdvantage]

No problem! :)