5-8 TRANSCUTANEOUS PACING (PARAMEDIC ONLY)

Clinical Indications:

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

Paramedic - Perform/Confirm All Above Interventions

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