View source for 5-8 TRANSCUTANEOUS PACING (PARAMEDIC ONLY)

'''Clinical Indications:'''

# Monitored heart rate less than 60 per minute with signs and symptoms of inadequate cerebral or cardiac perfusion such as:
## Severe chest pain
## Hypotension
## Pulmonary edema
## ALOC, disorientation, confusion, etc.
# PEA, where the underlying rhythm is bradycardic and reversible causes have been treated.

{| class="wikitable"
|'''Paramedic -''' ''Perform/Confirm All Above Interventions''
|}

# Attach standard four-lead monitor.
# Apply defibrillation/pacing pads to chest and back:
## One pad to left mid chest next to sternum, one pad to left mid posterior back next to spine.
# Set pacing option to 50 mA
# Adjust heart rate to 100 BPM for an adult, 100 BPM for pediatric patients.
# Note pacer spikes on EKG screen.
# Slowly increase output of 10 mA until capture of electrical rhythm on the monitor.
# If unable to capture while at maximum current output, stop pacing immediately.
# If capture observed on monitor, check for corresponding pulse and assess vital signs.
# Mechanical capture occurs when paced electrical spikes on the monitor correspond with palpable pulse.
# Consider the use of sedation and analgesia if patient is uncomfortable, per protocol.
# Document the dysrhythmia and the response to external pacing with EKG strips in the PCR.