Float Nurse

The patient was becoming cyanotic.  He did not have a palpable pulse.  By the time we could get BP machine to the room, the episode had passed.  He was noted to have his cell phone lying over his ICD/pacemaker so there is a question that the episode may have been induced by the cell phone.  The pacemaker was interrogated.   

The patient complained of "not feeling" well and shortness of breath.   

This is an interesting strip.  The patient has a ventricular pacemaker for what looks to be complete heart block.  The lead V1 you can see dissociated P waves.  In lead III we can see where the pacemaker has failed to capture resulting in a period of arrest.  In the V1 lead you can see the dissociated P waves more clearly during the period of arrest.  The bottom lead is an arterial wave form and you can see the dramatic fall in the blood pressure during the episode of the loss of capture.