External pacing device with discomfort management

Abstract

A method of controlling discomfort of a patient during external pacing by an external medical device includes detecting a cardiac condition of the patient; receiving, via a user interface, discomfort information descriptive of the discomfort experienced by the patient; determining from the discomfort information whether the patient is conscious or unconscious; responsive to determining from the discomfort information that the patient is unconscious, executing, via at least one therapy electrode disposed on the patient, at least one pacing routine, the at least one pacing routine being associated with the cardiac condition; and responsive to determining from the discomfort information that the patient is conscious, adjusting at least one characteristic of the at least one pacing routine.

What is claimed is: 
     
         1 . A method of controlling discomfort of a patient during external pacing by an external medical device, the method comprising:
 detecting a cardiac condition of the patient;   receiving, via a user interface, discomfort information descriptive of the discomfort experienced by the patient;   determining from the discomfort information whether the patient is conscious or unconscious;   responsive to determining from the discomfort information that the patient is unconscious, executing, via at least one therapy electrode disposed on the patient, at least one pacing routine, the at least one pacing routine being associated with the cardiac condition; and   responsive to determining from the discomfort information that the patient is conscious, adjusting at least one characteristic of the at least one pacing routine.   
     
     
         2 . The method of  claim 1 , further comprising adjusting the at least one characteristic of the at least one pacing routine to an upper bound of a range of values responsive to determining from the discomfort information that the patient is unconscious. 
     
     
         3 . The method of  claim 1 , wherein adjusting the at least one characteristic of the at least one pacing routine includes adjusting at least one of an amplitude of pacing pulses, a width of the pacing pulses, a rate of the pacing pulses, a waveform of the pacing pulses, a period of the pacing pulses, a duty cycle of the pacing pulses, or a ramp time constant of the pacing pulses. 
     
     
         4 . The method of  claim 1 , wherein receiving the discomfort information descriptive of the discomfort experienced by the patient comprises detecting an amount of pressure exerted by the patient on an element of the user interface. 
     
     
         5 . The method of  claim 4 , wherein receiving the discomfort information descriptive of the discomfort experienced by the patient comprises determining a duration of time the element of the user interface remains actuated. 
     
     
         6 . The method of  claim 4 , wherein detecting the amount of pressure exerted by the patient on the element of the user interface comprises detecting the amount of pressure exerted by the patient on a strain gauge, a force sensor, a piezoelectric transducer, or a rotating spring-loaded dial. 
     
     
         7 . The method of  claim 1 , wherein the user interface further comprises a force sensor, the method further comprising detecting, by the force sensor, a force applied by the user squeezing at least one surface of the force sensor. 
     
     
         8 . The method of  claim 1 , wherein adjusting at least one characteristic of the at least one pacing routine comprises optimizing the at least one characteristic along a scale comprising at least one of a linear scale, a logarithmic scale, or an exponential scale. 
     
     
         9 . The method of  claim 8 , wherein adjusting at least one characteristic of the at least one pacing routine comprises optimizing the at least one characteristic at least in part by executing a regression analysis using historical values of the at least one characteristic 
     
     
         10 . The method of  claim 1 , wherein the cardiac condition comprises at least one of bradycardia and asystole. 
     
     
         11 . The method of  claim 1 , wherein executing the at least one pacing routine comprises executing at least one of fixed rate pacing, fixed energy pacing, adjustable rate pacing, and capture management pacing. 
     
     
         12 . The method of  claim 1 , further comprising executing a baseline process during an initial fitting of the external medical device to the patient. 
     
     
         13 . The method of  claim 12 , wherein executing the baseline process comprises determining a range of values for a discomfort parameter corresponding to the at least one pacing routine. 
     
     
         14 . The method of  claim 12 , wherein executing the baseline process further comprises setting the at least one characteristic of the at least one pacing routine to an appropriate level based on a physiological condition of the patient. 
     
     
         15 . A non-transitory computer readable medium storing sequences of instructions executable by at least one processor, the sequences of instructions instructing the at least one processor to control discomfort of a patient during external pacing by an external medical device, the sequences of instructions including instructions to:
 detect a cardiac condition of the patient;   receive, via a user interface, discomfort information descriptive of the discomfort experienced by the patient;   determine from the discomfort information whether the patient is conscious or unconscious;   responsive to determining from the discomfort information that the patient is unconscious, execute, via at least one therapy electrode disposed on the patient, at least one pacing routine, the at least one pacing routine being associated with the cardiac condition; and   responsive to determining from the discomfort information that the patient is conscious, adjust at least one characteristic of the at least one pacing routine.   
     
     
         16 . The non-transitory computer readable medium of  claim 15 , wherein the sequences of instructions further include instructions to adjust the at least one characteristic of the at least one pacing routine to an upper bound of a range of values responsive to determining from the discomfort information that the patient is unconscious. 
     
     
         17 . The non-transitory computer readable medium of  claim 15 , wherein the sequences of instructions further include instructions to adjust the at least one characteristic of the at least one pacing routine includes adjusting at least one of an amplitude of pacing pulses, a width of the pacing pulses, a rate of the pacing pulses, a waveform of the pacing pulses, a period of the pacing pulses, a duty cycle of the pacing pulses, or a ramp time constant of the pacing pulses. 
     
     
         18 . The non-transitory computer readable medium of  claim 15 , wherein the instructions to receive the discomfort information descriptive of the discomfort experienced by the patient comprise instructions to detect an amount of pressure exerted by the patient on an element of the user interface. 
     
     
         19 . The non-transitory computer readable medium of  claim 15 , wherein the instructions to adjust the at least one characteristic of the at least one pacing routine comprise instructions to optimize the at least one characteristic along a scale comprising at least one of a linear scale, a logarithmic scale, or an exponential scale. 
     
     
         20 . The non-transitory computer readable medium of  claim 19 , wherein the instructions to adjust the at least one characteristic of the at least one pacing routine comprise instructions to optimize the at least one characteristic at least in part by executing a regression analysis using historical values of the at least one characteristic.