| Acute Anaphylaxis
| Basic Life Support
| Advanced Life Support
|Hypovolaemic or Haemorrhagic Shock
|Septic Shock and Sepsis
|Shock (General Assessment)
|Toxic Shock Syndrome
The technique poses no electrical threat to medical personnel, and complications are rare. See Bradycardia algorithm
- Ventricular capture rate is variable. May cause pain in awake patients
- Usually tolerated and may be life saving. Bridge to transvenous pacing.
- Capture rates are usually lower but range from 10% to 93%.
- Uses the defibrillator pads to pace heart.
- Pain may come from skeletal muscle contraction
- Apply first pad anteriorly over the palpable cardiac apex (or V3 lead location)
- Apply second pad posteriorly at the inferior aspect of the left scapula.
- Second pad can also be over right side of sternum as for defibrillation
- Place pads away from an ICD or PPM and remove any drug patches
- Clipping excess chest hair improves electrical contact. Ensure the skin is dry.
- Give sedation and analgesia. Midazolam + morphine IV titrated to effect.
- Select the mode to synchronizes the stimulus to avoid R on T
- Typical thresholds are 20 to 120 mA even to 200 mA
- Long pulse durations of 20 to 40 ms.
- Activate the pacer and set desired heart rate to 70/min
- Slowly increase output until capture is acquired
- Electrical capture can be judged on the cardiac monitor.
- Check pacer spike followed by a wide complex QRS complex
- Reassess pulse and BP and SaO2 and clinical assessment
- Give pain medication.
- Chest compression can be done simultaneously