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CASE #4 : IT’S SHOCKING!

Imagine this scenario. Your longterm cardiac cripple patient – the one you successfully rescuscitated from a VF arrest some 8 years ago and who has eked out an existence due to an implantable defibrillator – has finally succumbed to a chronic illness and is deceased.

You’ve managed to wade through the completion of the death certificate – but 3 hours later are telephoned by the Funeral Director who tells me that the patient is to be cremated.

Here’s the question – does the ICD need to be removed? If so, does it need to be deactivated first? And can you do this as a “Medical Macgyver” with just a multitool and a strong arm?

Needless to say it is a Saturday and the cardiology clinic is closed until Monday. The nearest tertiary hospital is 600km away…

Would you cut the wires?


3 Comments

  1. Hi there GP Rural land im here by invitation, yes you can be a Medical MacGyver I can read between the lines and i know you want to – BUT NO NO NO Do not not cremate without disabling and preferably removing. A simple magnet and everyday medical multi tool ( no need for the strong arm) – will do the trick.

    Option one (and best): place magnet over device to disable shocks and cut device from pocket – its basically just under the skin in fossa, remove device, cut wires, and leave leads insitu.

    Option two: mortician can place magnet over device and cut wires to disable and cremate only if no other option

    Option three: (and a great one) call device company ie” St Jude, Medtronic” and i can guarantee a tech will volunteer to come for a trip to the country and run disabling therapies, especially Kangaroo Island or any place that has a Big Something to get a photo with. 🙂

  2. KIdocs.org says:

    So Sharon – what happens if

    (a) cremate with the ICD in situ ?

    or

    (b) pull out my multi-tool and have a bash without disabling. Can they deliver a shock to the unwary mortician/rural doctor?

  3. Richard Abbott says:

    Agree with Sharon, either magnet and remove or call the technician.
    Should consider in palliative care patients as well. I had a patient who was dying and his wife reminded me he had a implanted defibrilator. I phoned the tech who was there a few hours later to disarm.
    The answer to (a) is explode and leave nasty chemicals (b) Yes (I think)

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About

Http://about.me/timleeuwenburg

Http://about.me/timleeuwenburg

I am a Rural Doctor on Kangaroo Island, South Australia with interests in EM, Anaes & Trauma. Avid user & creator of #FOAMed; EMST & ATLS Director, Instruct & Direct on ETMcourse.com; faculty for Critically Ill Airway course and smaccAIRWAY workshops. My sites include KIdocs.org & RuralDoctors.Net, affiliated with smacc Opinions expressed on these sites must not be used to make decisions about individual health related matters or clinical care as medical details vary from one case to another. Reader is responsible for checking information inc drug doses etc.

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