Cardiac Pacing

Question 1

When and How to perform percussion pacing?

Answer 1

When? Unstable / unconsciousness

How? Closed fist lateral lower sternum, 20 cm above chest, monitor ECG, if second person (check for pulse with each thump).

If not pluse, then slightly harder and then if still failing move around the praecordium.

Question 2

What is the preferable pacing position?

Answer 2

AP (overlying v2-v3; lower part of the left scapula and spine)

Question 3

What is the appropriate pacing rate?

Answer 3

60-90 BPM (a lower rate can be chosen for demand pacing in extreme bradycardia or ventricular standstill)

Question 4

Increase pacing voltage until you get a QRS with T wave. What then?

Answer 4

Check for a pulse and step the output up another 10mA

Question 5

If an ICD delivers inappropriate shocks, how do you disable?

Answer 5

With magnet

Question 6

What should you do with a person with an active ICD in place when they die?

Answer 6

Place a magnet over the ICD

Question 7

Can you do CPR on a patient with an ICD especially in light of the fact that it will be potentially shocking the patient?

Answer 7

Yes