Transcutaneous pacing

Treatment of PEA is similar to treatment of asystole. Both conditions require CPR, airway control, and IV access. DefibriUation should be avoided in asystole because the resulting parasympathetic discharge can reduce the chance of ROSC and worsen the chance of survival. If available, transcutaneous pacing can be attempted. 

SSRI selective sCTotonin reuptake inhibitor (class of drugs used to treat d ression, e.g., sCTtraline) SSS sick sinus s5mdrome stat immediately (Latin statim ) supl supplement or supplied supp suppository Susp suspension SVT supraventricular tachycardia Sx s5mptom S5md syndrome Sz seizure tab/tabs tablet/tablets tach tachycardia TB tubCTCulosis TBI traumatic brain injury TCA tricyclic antidqjressant (class of drugs commonly used to treat d ression, e.g., amitriptyline) TCP transcutaneous pacing TD transdermal TFT thyroid function test TEA transient ischemic attack tid three times a day (Latin ter in die ) tine tincture TMP trimethoprim (type of antibiotic)... 

Proper electrode placement is the single most important fector for determining whether transcutaneous pacing will be effective. The proper position of the cathode (negative) electrode is directly over the cardiac apex or over the position of ECG chest leads V3 (Fig. 7.1). The anode (positive) electrode is placed either posteriorly (recommended) on the back between the spine and the lower half of the left or right scapulae, or, alternatively, if the back is inaccessible, over the right upper chest centered approximately 6-10 cm above the... 

Fig. 7.1 Correct position of transcutaneous pacing electrodes. Top Anteroposterior positioning with the cathode (circle) over the cardiac apex and the anode (rectangle) in the back between the spine and the right scapula (the space between the spine and left scapula can also be used). Bottom Anterior-anterior position with the cathode over the cardiac apex and the anode on the right chest.

Complications from transcutaneous pacing are extremely rare (3,4). The primary reasons for intolerance by patients are pain and cough. Although newer designs have lowered the current densities delivered at the surface of the skin, thereby reducing the incidence of cutaneous nerve stimulation. 

Pacing system inhibition from interference is more important in the pacemaker-dependent patient. If inhibition is observed in a pacemaker-dependent patient, electrocautery application should be limited to 1-2 s with a rest period of approximately 10 s. This will allow the pacemaker to function properly for a greater portion of the time. In some cases back-up temporary transvenous or transcutaneous pacing will be required, or the pacemaker can be programmed to the asynchronous mode of function. 

Early transcutaneous pacing I.V. vasopressin, epinephrine, and atropine... 

Transcutaneous pacing, if needed, until the arrhythmia resolves... 

Transcutaneous pacing initiated quickly when indicated and I.V. dopamine infusion, epinephrine, or combination of these drugs... 

Transcutaneous pacing, also referred to as external or noninva-sive pacing, involves the delivery of electrical Impulses through externally applied cutaneous electrodes. The electrical impulses are conducted through an intact chest wall using skin electrodes placed in either anterior-posterior or sternal-apex positions. (An anterior-posterior placement is shown here.)... 

Transcutaneous pacing is the pacing method of choice in emergency situations because ifs the least invasive technique and it can be instituted quickly. 

Prepare patient for treatments as needed, such as drug administration (atropine, dopamine, epinephrine) transvenous or transcutaneous pacing or permanent pacemaker insertion for a chronic, symptomatic condition. 

Early transcutaneous pacing may be considered, and l.V. epinephrine and atropine is given. 

Maintain transcutaneous pacing imtil the arrhythmia resolves. (See Bradycardia algorithm, pages 38 and 39.)... 

If the patient has an arrhythmia, prepare for use of antiarrhyth-mics, transcutaneous pacing patches (or transvenous pacemaker), defibrillation, or epinephrine. 

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