Pacemaker

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Introduction

Pacemakers can be used to apply repeated electrical stimulation to the heart. can be temporary or permament.

shows up as a long line in the QR, or it can show up as a little blip.

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Transcutaneous Pacing

Transcutaneous pacing (TCP) is used during advanced cardiac life support (ACLS) for treatment of symptomatic bradycardia with poor perfusion.

TCP shocks the heart through electrodes placed on the skin. Many manual defibrillators can perform TCP.

It is used in situations of:

• hemodynamically unstable bradycardia
• acute myocardial infarction, with sick sinus syndrome, Mobitz II second-degree AV block, third-degree AV block, or new bundle branch block
• bradycardia with symptomatic ventricular escape rhythms
• tachycardias refractory to drug therapy or electrical cardioversion

Conscious patients will require procedural sedation (i.e., benzodiazepines and opioids) unless unstable.

Confirm mechanical capture by assessing radial pulse; do not use the carotid pulse, as muscle activation caused by the pacing may mimic a pulse.

 

Current should be set a t 2mA above dose at which consistent capture is observed for safety.

Contraindications include:

• severe hypothermia
• asystole

 

 

 

 

Resources and References

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