Transcutaneous Pacing Indications & Management

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.