Page 248 - 2023 SMOG Digital

TRANSCUTANEOUS

(EXTERNAL)

CARDIAC PACING

CLINICAL INDICATIONS:
• Patients with pulse rate <60 (or appropriate for age) and signs of inadequate cerebral or end-organ
perfusion.
CONTRAINDICATIONS:
• None
PROCEDURE:
• Ensure patient attached to monitor and defibrillator with external cardiac pacing capabilities.
• Time-permitting, ensure adequate IV/IO access prior to pacing. Also, may administer sedative agent
(midazolam) prior to beginning pacing.
• Turn selector switch to “Pace.”
• Set rate to twice the patients intrinsic rate (often 70-80 for adult, 100 for pediatric).
• Set energy level to lowest setting and gradually increase until capture is obtained (each pacer spike
followed by QRS).
• Once capture obtained, ensure pulse and vital signs correspond with pacing. Evaluate patient for
improvement. Monitor and continue sedation as needed.
• If fails to capture at maximal setting, discontinue pacer.
• At any time, if patient degenerates and needs CPR – begin compressions immediately. Pacer pads are
insulated and it is okay to perform compressions with pacer running.
• Document procedure, results, and vital signs on run sheet following mission.

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