Procedure 22 - Cardiac: External Pacing

What heart rate defines symptomatic bradycardia for external pacing indication?

Less than 60 beats per minute.

What chest symptom indicates poor perfusion for external pacing?

Chest pain.

What blood pressure symptom indicates poor perfusion for external pacing?

Hypotension.

What respiratory symptom indicates poor perfusion for external pacing?

Pulmonary edema.

What mental status symptom indicates poor perfusion for external pacing?

Acute altered mental status suggesting poor perfusion.

What cardiac rhythm finding with poor perfusion indicates external pacing?

Ventricular ectopy with signs of poor perfusion.

How is the cardiac monitor attached for external pacing?

Using limb leads.

Are the limb leads protected from pacing energy?

Yes, the leads are internally protected from the pacing energy.

Where are defibrillation/pacing pads applied for external pacing?

The anterior/posterior or anterior/lateral positions.

What is selected on the cardiac monitor to begin external pacing?

The pacing option.

What heart rate should external pacing be adjusted to for an adult?

60 bpm.

What heart rate should external pacing be adjusted to for a 1-8 year old child?

80 bpm.

What heart rate should external pacing be adjusted to for an infant under 1 year old?

100 bpm.

What should be noted on the ECG and monitor screen during external pacing?

Pacer spikes.

At what output should external pacing begin?

10 mAmps, gradually increased until capture of electrical rhythm is seen on the monitor.

What ECG finding usually indicates electrical capture during external pacing?

A widened QRS complex followed by an ST segment and T wave.

What should be done if unable to achieve capture at maximum current output during external pacing?

Stop pacing immediately.

What pulses should be checked to confirm mechanical capture during external pacing?

The right radial or femoral pulse.

What pulses should be avoided when assessing mechanical capture during external pacing, and why?

The carotid and left radial arteries, because muscular contractions from the pacing pulse may cause misinterpretation.

What device can be considered to confirm pulse during external pacing?

A Doppler device.

What should be strongly considered during external pacing due to patient discomfort?

The use of sedation or analgesia, since transcutaneous pacing is painful.

What should be documented after external pacing?

The dysrhythmia and the response to external pacing in the PCR.

What provider level can perform external pacing per CFD protocol?

EMT-P.