EMCrit Podcast
EMCrit Wee - Case of Failure of Pulse Ox to Confirm Transcutaneous Pacemaker (TCP) Capture with Mathieu Brunet
Jul 8, 2023
Cardiac emergencies expert Mathieu Brunet discusses a case where pulse oximetry failed to confirm Transcutaneous Pacemaker capture, highlighting the challenges of interpreting pulse oximetry waveforms and SVO2 readings in critical care. The podcast explores the complexities of arterial venous shunting, muscular contractions mimicking pulsation, and the need for alternative methods like ultrasound for confirming mechanical capture during pacing interventions.
15:49
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Quick takeaways
- Relying on pulse oximetry alone may lead to misinterpretation of mechanical capture during transcutaneous pacing.
- Venous pulsations and hyperoxia can cause inconsistent pulse oximeter readings, necessitating alternative confirmation methods for pacing efficacy.
Deep dives
Realization About Pulse Oximetry and Mechanical Capture
The podcast episode shares a case report involving a patient with a ventricular escape rhythm paced with a transcutaneous pacer. Initially, the physician thought there was mechanical capture based on a good waveform in the pulse oximeter readings and assumed the pacing was effective. However, upon manual inspection of the patient's femoral pulse, it was discovered that the patient was still bradycardic, indicating a lack of true mechanical capture. This highlighted the potential pitfall of relying solely on pulse oximetry to confirm mechanical capture during transcutaneous pacing.
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