Transcutaneous Pacing

Last Updated on by frcemuser

  • Position the pads
  • Select an appropriate pacing rate; usually in the range of 60 – 90 bpm
  • If the pacing device has an adjustable energy output, set this at the lowest value and turn on the pacemaker; gradually increase the output whilst observing the patient and the ECG; as the current is increased the muscles of the chest wall will contract with each impulse and a pacing ‘spike’ will appear on the ECG; increase the current until each pacing spike is followed immediately by a QRS complex indicating electrical capture
  • If the highest current setting is reached and electrical capture has not occurred, try changing the electrode positions; continued failure to achieve electrical capture may indicate non-viable myocardium
  • Having achieved electrical capture with the pacemaker, check that each paced QRS complex is followed by a pulse; a palpable pulse confirms a mechanical response of the heart to the paced QRS complex; good electrical capture that failures to generate a pulse constitutes PEA, if necessary provide chest compressions
  • When transcutaneous pacing produces an adequate cardiac output seek expert help immediately to arrange emergency transvenous pacing

 

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