Standards Procedure (Skill)
Clinical Indications: Level: EMT-P only
Ø Patients with symptomatic bradycardia after no response to atropine or primary treatment if unable to start an IV line
Ø Patients in symptomatic 2nd degree or 3rd degree heart block
Ø If used in asystole, it must be used early
Ø Pediatric patients requiring external transcutaneous pacing require the use of pads appropriate for pediatric patients per the manufactures guidelines
Procedure
a. Oxygen, ECG monitor, IV (if possible) should be in place prior to pacing.
b. Confirm the presence of the dysrhythmia and evaluate the patient’s hemodynamic status. (Strips must accompany for verification and documentation).
c. Adjust the QRS amplitude so the monitor can sense the intrinsic QRS activity.
d. Apply the pacing pads to the patient’s chest in either of the following positions: anterior/anterior or anterior/posterior.
e. Attach the pacing pads to the therapy cable from the monitor.
f. Turn the pacer on.
g. Observe the ECG screen for a “sense” marker for each QRS complex. If a “sense” marker is not present, readjust the ECG size or select another lead.
h. Set the desired pacing rate (60-80).
i. Start at the lowest energy level and increase current slowly while observing the ECG screen for evidence of external electrical pacing capture.
j. Assess the patient’s response to the pacing therapy by checking a pulse for mechanical capture.
k. If no mechanical capture found, increase energy setting and reassess.
l. Consider the use of sedation or analgesia if the is uncomfortable.
m. Document the dysrhythmia, procedure and patient response on the ACR.
Certification Requirements:
Successfully complete an annual skill evaluation including the indications, contraindications, technique, and possible complications of the procedure.