Question

True or False: Transcutaneous pacing should be used on a bradycardic individual with insufficient perfusion before any other intervention

Answer 1

Transcutaneous pacing should be used on a bradycardic individual with insufficient perfusion before any other intervention- False

As we First need to Start with Medical Treatment i.e, Atropine rather then Transcutaneous Pacing.

Transcutaneous Pacing (TCP) is a temporary means of pacing a patient’s heart during an emergency and stabilizing the patient until a more permanent means of pacing is achieved.

It is accomplished by delivering pulses of electric current through the patient’s chest, stimulating the heart to contract. The most common indication for TCP is symptomatic bradycardia, most commonly resulting from acute MI, sinus node dysfunction, and complete heart block.

METHOD OF INSERTION AND/OR USE

• place pads in AP position (black on anterior chest, red on posterior chest)
• connect ECG leads
• set pacemaker to demand
• turn pacing rate to > 30bpm above patients intrinsic rhythm
• set mA to 70
• start pacing and increase mA until pacing rate captured on monitor
• if pacing rate not captured at a current of 120-130mA -> resite electrodes and repeat the above.
• once pacing captured, set current at 5-10mA above threshold

Indications for TCP include:

• hemodynamically unstable bradycardias that are unresponsive to atropine
• bradycardia with symptomatic escape rhythms that don't respond to medication
• cardiac arrest with profound bradycardia (if used early)
• pulseless electrical activity due to drug overdose, acidosis, or electrolyte abnormalities
• overdrive pacing for refractory tachyarrhythmias after failure of electrical cardioversion and drug therapy.

Contraindications to TCP include:

• severe hypothermia
• prolonged bradyasystolic cardiac arrest.