Transcutaneous Pacing Indications & Management
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Questions and Answers

Which condition is an indication for transcutaneous pacing?

  • Asymptomatic tachycardia
  • Hemodynamically unstable bradycardia (correct)
  • Stable bradycardia
  • Pulseless electrical activity

    • What is a common clinical condition that may require pacing readiness?

  • Myocardial infarction with bradycardia (correct)
  • Sinus tachycardia
  • Stroke
  • Atrial fibrillation

    • Transcutaneous pacing is indicated for which type of heart block?

  • First-degree AV block
  • Premature atrial contractions
  • Second-degree type I AV block
  • Second-degree type II AV block (correct)

    • What is the pacing rate that should be initially set during transcutaneous pacing?

    <p>60 beats per minute (A)</p> Signup and view all the answers

    How should the pacing current be adjusted to achieve electrical capture?

    <p>Increase by 20 milliamps increments (A)</p> Signup and view all the answers

    What action should be taken if there is electrical capture but no pulses?

    <p>Continue pacing and initiate CPR (D)</p> Signup and view all the answers

    What adjunctive therapy is appropriate for a conscious patient undergoing pacing with a SBP > 90 mm Hg?

    <p>Midazolam for sedation (C)</p> Signup and view all the answers

    What is the maximum dose of midazolam for sedation?

    <p>5 mg (A)</p> Signup and view all the answers

    What is the maximum dose of morphine sulfate for analgesia?

    <p>10 mg (A)</p> Signup and view all the answers

    What is the maximum single dose of fentanyl during transcutaneous pacing?

    <p>100 mcg (B)</p> Signup and view all the answers

    What medication is NOT indicated for adjunctive therapy during pacing?

    <p>Atropine (D)</p> Signup and view all the answers

    What is the pediatric guideline for transcutaneous pacing?

    <p>Requires telemetry physician order only (D)</p> Signup and view all the answers

    What type of block might necessitate pacing in the setting of an MI?

    <p>Third-degree AV block (A)</p> Signup and view all the answers

    Which bundle branch block pattern is an indication for pacing?

    <p>Right or left alternating bundle branch block (B)</p> Signup and view all the answers

    What is a contraindication to transcutaneous pacing?

    <p>None listed (C)</p> Signup and view all the answers

    What is the sedation dose for diazepam during pacing?

    <p>5 mg IV/IO (C)</p> Signup and view all the answers

    What should be done if pacing pads fail to achieve capture?

    <p>Increase the current in 20 mA increments (A)</p> Signup and view all the answers

    What is the initial pacing mode for transcutaneous pacing?

    <p>Demand pacing mode (C)</p> Signup and view all the answers

    When should ketamine be used during transcutaneous pacing?

    <p>Only with physician order (C)</p> Signup and view all the answers

    What is the key procedural step if no electrical capture occurs during pacing?

    <p>Increase the pacing current until capture is achieved (A)</p> Signup and view all the answers

    Study Notes

    Transcutaneous Pacing Indications & Management

    • Hemodynamically unstable bradycardia is an indication for transcutaneous pacing, not stable bradycardia. A common clinical condition requiring pacing readiness is myocardial infarction with bradycardia.
    • Second-degree type II AV block is an indication for transcutaneous pacing.
    • Initially set the pacing rate to 60 beats per minute.
    • Increase the pacing current in 20 milliamp increments until capture is achieved.
    • If electrical capture occurs but no pulses are seen, continue pacing and initiate CPR.
    • Midazolam is appropriate adjunctive therapy for a conscious patient undergoing pacing with a systolic blood pressure (SBP) > 90 mmHg, not lidocaine, dopamine, or atropine.
    • The maximum dose of midazolam is 5 mg.
    • The maximum dose of morphine sulfate for analgesia is 10 mg.
    • The maximum single dose of fentanyl is 100 mcg.
    • Atropine is not an indicated adjunctive therapy during pacing.
    • Pediatric transcutaneous pacing requires a telemetry physician's order, not adult pads, and starts at a pacing rate deemed appropriate for the child's condition.
    • A third-degree AV block in the setting of an MI might necessitate pacing. Alternating right or left bundle branch blocks are indications for pacing, not stable varieties.
    • Hypotension and hemodynamic instability are contraindications to transcutaneous pacing.
    • A 5 mg IV/IO dose of diazepam is a common sedation dose for use during pacing.
    • If pacing pads fail to capture, increase the current in 20 mA increments.
    • The initial pacing mode is fixed-rate pacing.
    • Ketamine use during transcutaneous pacing requires a physician's order and isn't first-line. It can be an alternate to midazolam/diazepam for sedation.
    • If no electrical capture occurs, systematically increase the pacing current until capture is achieved.

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    Description

    This quiz covers the essential indications and management protocols for transcutaneous pacing, primarily focusing on hemodynamic instability and various cardiac conditions. It addresses important medication dosages and therapeutic adjuncts related to pacing. Test your knowledge on pacing techniques and best practices for patient care.

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