chapter 10- pacing

Question 1

what are the methods of non-invasive pacing?

Answer 1

percussion pacing (fist pacing)
transcutaneous pacing

Question 2

what are the methods of invasive pacing?

Answer 2

transvenous pacing

permanent pacing i.e. pacemaker

Question 3

how do you perform percussion pacing?

Answer 3

1) side of closed fist deliver repeated thumps to the precordium, just lateral to the left sternal edge
2) raise hand to 20cm before each thump
3) monitor ECG and assess whether a QRS is generated by each thump
4) if initial thumps do not produce QRS complexes, then try additional thumps
5) if this fails then adjust position around the praecordium in attempt to find a position where a QRS complex is produced

Question 4

how to perform transcutaneous pacing?

Answer 4

1) position leads
2) select appropriate pacing range - usually 60-90
3) set the energy range at the lowest if adjustable, then slowly increase until each pacing spike is followed by a QRS
3) if you have reached the highest current and pacing is not achieved then reposition the electrodes
4) once you have achieved pacing on the ECG, check that there is a pulse following each QRS complex

Question 5

what position should the pericardial leads be in for transcutaneous pacing?

Answer 5

right pectoral and apex position usually - this must be applied to the chest wall and not onto breast tissue

Question 6

when should anterior-posterior position be used in transcutaneous pacing

Answer 6

if unable to place in typical pectoral-apex position i.e. due to body mass or chest trauma, then place anterior pad on left anterior chest wall beside the sternum + the posterior pad between the lower part of the left scapula and spine

Question 7

where should defibrillator pads be placed in a patient who has an ICD and has a cardiac arrest

Answer 7

8cm away from the ICD