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previews",[218,228,233,238,245],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},158,{"platform":223,"name":212,"url":224,"size":225},"YouTube","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=DmEHhC6OD2U",{"width":226,"height":227},200,113,{"type":229,"data":230},"free_text",{"readDurationInSeconds":231,"text":232},5.333333333333333,"\u003Cp>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.\u003C\u002Fp>",{"type":229,"data":234},{"readDurationInSeconds":235,"title":236,"text":237},12.533333333333333,"Join our Emergency Procedures Masterclass (Part 1) course today!","\u003Cp>Learn how to perform emergency procedures like a pro! With our \u003Cstrong>\u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Femergency-procedures-masterclass\">Emergency Procedures Masterclass (Part 1)\u003C\u002Fa>\u003C\u002Fstrong> course, you'll get the lowdown on the tools involved in each treatment or diagnostic procedure, understand when and how to perform them, and determine how to anticipate and minimize potential complications. \u003C\u002Fp>",{"type":239,"data":240},"cta",{"readDurationInSeconds":241,"text":242,"buttonText":243,"buttonUrl":244},3.466666666666667,"Become a great clinician with our video courses and workshops","Start learning for free","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister",{"type":229,"data":246},{"readDurationInSeconds":247,"title":248,"text":249},70.39999999999999,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cstrong>[00:00:00] \u003C\u002Fstrong>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 \u002F kg. For an average male, this is achieved around 70 to 80 mA, but obesity and underlying lung disease \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:00:30]\u003C\u002Fstrong> 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 \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:01:00] \u003C\u002Fstrong>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 \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:01:30]\u003C\u002Fstrong> 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 \u003C\u002Fp>\u003Cp>\u003Cstrong>[00:02:00] \u003C\u002Fstrong>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.\u003C\u002Fp>",{"courses":251,"showAwardsBelow":48},[252],{"id":253,"isFreeCmeCourse":254,"title":255,"type":256,"specialization":257,"teachers":259,"cmeCredits":261,"teacherIllustration":262,"backgroundImage":263,"relativeUrl":264,"lastChanged":265,"created":266,"description":267,"relativeURL":264,"meta":268},5364,false,"Emergency Procedures Masterclass (Part 1)","course",[258],"Emergency medicine and critical care",[260],"Siamak Moayedi, MD",4,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55f1f-61b4-4ac9-8b50-644a30cb3886","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55f20-4e4d-4ec0-84db-e1d65ce22669","\u002Fcourses\u002Femergency-procedures-masterclass-part-1","1768935864","1535559802","Don’t let emergency medicine stump you. Learn how to perform some of the most essential procedures in emergency medicine—from lumbar punctures and vertigo maneuvers to transvenous pacing and defibrillation—so you can diagnose and treat important conditions with confidence. We’ll teach you when to use which procedure, how to perform it safely, and how to troubleshoot common complications.",{"duration":269,"quizzes":270,"lessons":271},8634,9,60,{"id":273,"name":260,"image":274,"profession":275,"relativeUrl":278,"specializations":279},5365,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-1064-4074-817b-0eb5de6ded74",{"name":276,"description":277},"Emergency medicine physician","Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.","\u002Fteachers\u002Fsiamak-moayedi-md",[258,280],"Pulmonary",95,"2m",[284,311,330],{"id":285,"title":286,"text":287,"image":288,"author":296,"path":304,"readDuration":305,"readDurationFormatted":306,"internal":307},1350,"How to Recognize INOCA (ANOCA) on an Exercise Stress Test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":289,"title":290,"size":291,"location":293},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).","",{"width":292,"height":292},1200,{"bucket":294,"key":295},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":297,"title":298,"relativeURL":299,"image":300,"professionLong":301,"profession":302,"weight":261},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":303},"Internist","\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,"3m",{"created":308,"updated":309,"published":310},1778115738,1778118425,1778118255,{"id":312,"title":313,"text":314,"image":315,"author":321,"path":323,"readDuration":324,"readDurationFormatted":325,"internal":326},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":316,"title":290,"size":317,"location":319},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":318,"height":318},600,{"bucket":294,"key":320},"\u002F2026-04\u002FC121_magazine image.png",{"id":297,"title":298,"relativeURL":299,"image":300,"professionLong":301,"profession":322,"weight":261},{"name":303},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":327,"updated":328,"published":329},1777403036,1777572381,1777412421,{"id":331,"title":332,"text":333,"image":334,"author":339,"path":342,"readDuration":343,"readDurationFormatted":344,"internal":345},1347,"Outpatient care for COPD exacerbations","Most acute COPD exacerbations can be managed with outpatient treatment. Learn how to treat mild and moderate COPD exacerbations—and when to escalate care.",{"alt":335,"title":290,"size":336,"location":337},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":318,"height":318},{"bucket":294,"key":338},"\u002F2026-04\u002FC133(4)_ exacerbations_magazine image.png",{"id":273,"title":260,"relativeURL":278,"image":274,"professionLong":277,"profession":340,"weight":341},{"name":276},1533,"\u002Fmagazine\u002Facute-copd-exacerbation-treatment",191,"4m",{"created":346,"updated":347,"published":348},1776705362,1776710540,1776710541,{"seo":350,"og":352},{"title":351,"description":213},"Mastering transcutaneous pacing | Medmastery",{"title":351,"description":213,"image":353},{"alt":290,"title":290,"size":354,"location":357},{"width":355,"height":356},818,494,{"bucket":294,"key":358},"\u002Fmigrated-images\u002FScreen Shot 2018-09-20 at 3.19.14 pm.png",{"id":360,"created":361,"updated":362,"published":361},256,1535552894,1655189586]