In this video, from our Emergency Procedures Masterclass course, you'll learn how to transcutaneously pace a patient and what to do if a patient doesn't achieve capture.
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[00:00:00] The first step is to turn the machine to pacer mode. You also have to connect the monitor leads and the pads to the pacer. Select the heart rate, you'll need at least 80 beats per minute. Next, select the output. A typical output needed to reach the heart is 1 mA / kg. For an average male, this is achieved around 70 to 80 mA, but obesity and underlying lung disease
[00:00:30] may require higher amounts of energy. So, if your patient doesn't achieve capture, continue to increase the output by 5 mA every two seconds, until electrical capture occurs. Capture means that the pacer spikes are followed by a wide QRS. From the beginning, as soon as you turn on the pacer function and increase the output above zero, you'll see the pacer spikes on the monitor. But if the output is not high enough for
[00:01:00] electrical capture, you will not see a wide QRS immediately following the spikes. Continue to increase the output, until you see electrical capture. On the other hand, if you don't have capture initially, go ahead and decrease the output until you lose capture and then set the output to 5 mA above where you lost capture. The idea here is to use the lowest amount of energy required to avoid unnecessary pain
[00:01:30] and muscle injury. Confirmation of mechanical capture can be done by feeling the pulse or following the heart rate of the pulse oximeter, which doesn't depend on electrical sensing. Now that the emergency is resolved and the patient has a better pulse and blood pressure, it's time to administer the sedative and pain medicines. Sometimes, because of COPD or obesity, external pacing will simply not work. And if it is working, it's only a temporary solution because it's painful and can lead to
[00:02:00] hyperkalemia and rhabdomyolysis. So, transcutaneous pacing is only a temporary solution while preparing for the transvenous pacer, unless the cause of the bradycardia can be rapidly reversed, like in the case of an overdose.