2015 Trumbull Memorial Hospital Demo

External Transcutaneous Pacing

External Transcutaneous Pacing

Steps

Performed? Yes No

1. Identify clinical indications  Critical patient secondary to bradycardia (AMS, hypotension, pulmonary edema)  Other methods of correcting the critical bradycardia failed, or patient has a high degree (2° type II or 3°) AV block.

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2. Clean and dry skin sites for pacing electrodes.

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3. Recommended placement of pads:  Anterior electrode placed over the cardiac apex (approx. the V2-V3 position on a 12-Lead)  Posterior electrode placed on the left posterior chest beneath the scapula, behind the heart  Avoid placing the pads directly over bony prominences such as the sternum and scapula 4. Rate, mode, and amperage will be adjusted by the crew to achieve an adequate degree of perfusion as indicated by the assessment of peripheral circulation.  Set heart Rate no less than 60, no more than 80 bpm  Assess for electrical capture (a wide complex following every pacer spike)  Assess for mechanical capture (corresponding pulse with every paced beat)  Assess mental status, capillary refill, blood pressure 5. Pediatric Patients : Increase to the minimum amperage necessary to maintain electromechanical capture, criteria same as adult

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6. Synchronize pacer with intrinsic rhythm to avoid inducing ventricular arrhythmias.

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130

EMR

EMT

AEMT

Paramedic

Extended