Adult Medical Emergency Handbook - Scottish Intensive Care Society

EXTERNAL CARDIAC PACING
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Main Indications (as below pending transvenous pacing)
• Complete heart block.
• Ventricular standstill.
• Symptomatic bradycardia unresponsive to atropine.
• Risk of asystole: see algorithm.
Equipment
• External pacing defibrillators are located in:
WGH:- ARAU, ICU Ward 20, Ward 26 and some other wards.
RIE:- A&E, ICU, CCU Ward 114 and some other wards.
SJH:- A&E, CCU (spare machines are located in the resuscitation
department and Medical Physics).
See current cardiac arrest trolley list for full location list.
Method
• Appropriate gel pads are applied to the chest in the defibrillator
paddle sites on front and back. There is a diagram on the outside
of the bag in which they are provided.
• The ECG electrodes from the defibrillator monitor must be
attached to the patient or it will not pace.
• The starting default settings which appear when you press the on
button are
• Mode is demand: don’t change this.
• Rate 70bpm: can be increased or decreased to achieve the
optimal haemodynamic condition.
• Power: 30mA: can be increased to gain capture. The lowest
level which is effective should be selected.
• External pacing can be uncomfortable, painful and distressing.
Titrate IV morphine for comfort and add 0.5-1mg midazolam
if distressed. Be careful with this potentially destabilising
combination. Monitor continuously (ECG, SpO 2 and BP) and reassess
frequently.
INTRAVENTRICULAR OR BIFASICULAR BLOCK
Right bundle branch block plus left or right axis deviation (-30 0 or > +90 0 )
constitutes bifasicular block. Following anterior myocardial infarction,
unless known to be long-standing, it is an indication for considering
insertion of a temporary pacing electrode. If more severe conduction
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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