First Things First (assess & treat for the following)

• If patient is in cardiac arrest, treat per ACLS.
• Presence of an ICD does not preclude external defibrillation.
• If hemodynamically unstable tachycardia and the ICD is not effective, proceed with external defibrillation.
• Do not place external electrodes directly over the ICD.
• Provide CPR without hesitation but wear gloves to decrease sensation of internal shocks (not a health risk but uncomfortable).

• After hours, call device reps for assistance:

• Guidant/Boston Scientific: 1-800-227-3422
• Medtronic: 1-800-878-5616
• St. Jude Medical: 1-800-722-3423