Transcutaneous Pacing
OVERVIEW
- temporary cardiac pacing using pads or paddles applied externally to the chest
USES/INDICATIONS
- bradycardia unresponsive to drug therapy
- 3rd degree heart block
- Mobitz type II second-degree heart block when haemodynamically unstable or operation planned
- overdrive pacing
- asystole
METHOD OF INSERTION AND/OR USE
- place pads in AP position (black on anterior chest, red on posterior chest)
- connect ECG leads
- set pacemaker to demand
- turn pacing rate to > 30bpm above patients intrinsic rhythm
- set mA to 70
- start pacing and increase mA until pacing rate captured on monitor
- if pacing rate not captured at a current of 120-130mA -> resite electrodes and repeat the above.
- once pacing captured, set current at 5-10mA above threshold
COMPLICATIONS
- failure to pace and failure to capture
- discomfort
VIDEO
Jason Nomura (2013) on the practical aspects of emergent pacing:
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC