Transcutaneous Pacing (Internal Medicine)

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  • Symptomatic and hemodynamically compromising bradycardias unresponsive to atropine
  • Asystole within the first few minutes in the treatment
  • Ventricular fibrillation (see Defibrillation for further details)
  • Awake, hemodynamically stable patients
  • Severe hypothermia
  • Nonintact skin at the site of pacemaker pad placement
  • Portable transcutaneous pacemaker
    • Pacer pads
    • Skin cleanser/shaving supplies if needed
  • Sedation medications
  • Resuscitation supplies (adjuncts for unstable patients)
    • Intravenous access (see Intravenous Cannulation for further details)
    • Advanced airway management equipment See Basic Airway Management for further details.
  • The heart lies behind the sternum, with the base at about the third intercostal space just to the right of the sternum. The apex is at the fifth intercostal space, inferior to the nipple and usually just medial to the nipple.
  • Electrode pad placement
    • Anterior pad: just to the left of the sternum at the point of maximum impulse (PMI)
    • Posterior pad: to the left of the spine, just below the left scapula

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • To avoid burning the patient, do not leave pads in the same place for more than a few hours.
  • Confirm that the patient has adequate sedation and analgesia.
  • Treat the underlying arrhythmia and plan for definitive pacing if needed.
  • Failure to recognize ventricular fibrillation
  • Pain
  • Skin burns
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