Progressive Care Nursing Certification (PCCN) Practice Exam

What is the emergency treatment protocol for ventricular dysrhythmias in a patient with an ICD pacemaker?

1. Do not defibrillate with external paddles if vfib occurs

2. CPR is not indicated if the ICD is firing correctly

3. Avoid placing the defibrillation paddles directly over the ICD

4. Apply a magnet to turn off all functions of the ICD

The correct answer is: Avoid placing the defibrillation paddles directly over the ICD

The correct choice emphasizes the need to avoid placing defibrillation paddles directly over the ICD (Implantable Cardiac Defibrillator) when treating a patient experiencing ventricular dysrhythmias, such as ventricular fibrillation. This is crucial because the presence of the ICD can interfere with the delivery of external shocks, potentially causing harm or ineffective treatment. When paddles are placed directly over the device, there is a risk that the shock could cause damage to the ICD itself, affect its function, or result in poor energy transfer to the myocardium, which could hinder the resuscitation efforts. In situations of ventricular dysrhythmias, the ICD is designed to intervene and correct abnormal heart rhythms autonomously. Ensuring that the paddles are placed away from the device helps preserve the patient's existing defibrillation capabilities and maintains the integrity of the ICD for potential future interventions. The other options are important to consider in the context of emergency response protocols, but they do not provide the same critical intervention principle related to placement of defibrillation paddles. Understanding the unique considerations for patients with an ICD is key for effective emergency management of dysrhythmias.