Transcutaneous pacing—identifying the tools

In this video, you'll learn how to operate an external cardiac pacer and explore the medications you can use to improve tolerability.

Siamak Moayedi, MD
Siamak Moayedi, MD
29th Jul 2018 • 2m read

Most defibrillator machines can be converted into transcutaneous pacers, if required. In this video, from our Emergency Procedures Masterclass, you'll learn how to use external pacer pads in patients with symptomatic bradycardias and explore the medications you can use to improve tolerability.

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Video Transcript

[00:00:00] Most defibrillator machines can be converted to a transcutaneous pacer, by turning on the pacer feature. Pacer pads are placed in the same way as the defibrillator but because the pads cannot both sense and pace at the same time, you have to connect the monitor leads to the machine. Once the pace feature is turned on, there are only two settings you need to control.

[00:00:30] The right button sets the heart rate you want and the output is the amount of energy, measured in milliamps, required to conduct electricity through the patient's chest wall and heart. The bigger the patient, the more output required. You should generally aim for 1 mA / kg, so an average sized adult, who might weigh 70 kg, will require approximately 70 mA. But kids and small adults may require less energy.

[00:01:00] The constant electrical shocks will depolarize all muscle cells between the two pads and will cause involuntary contraction of the chest wall muscles. This is really uncomfortable for the patient and may even cause them not to be able to tolerate the procedure. Pain medications and sedatives such as fentanyl and midazolam can help decrease the discomfort, until the painless transvenous pacer is placed. Now that you are familiar with the tools, let's learn how to

[00:01:30] perform transcutaneous pacing.