ELECTRICAL THERAPY
TRANSCUTANEOUS PACING

LEVEL: Paramedic

Indications:
This procedure may be performed on any patient experiencing:
A. &nbap;Hemodynamically unstable bradycardia
B.  Unstable clinical condition that is likely because of bradycardia
C.  For pacing readiness (i.e. standby mode) in the setting of MI with bradycardia, second degree type II AV block, third degree AV block, new left or right alternating BBB or bifascicular block
D.  Overdrive pacing of tachycardias refractory to drug therapy or electrical cardioversion

Contraindications: None

Adjunctive therapy:
In the conscious patient with a systolic blood pressure of >90mmHg consider:
Sedation:
Midazolam 0.1 mg/kg IN/IM/IV. May repeat every five minutes at 0.05 mg/kg IN/IM/IV or;

Diazepam 5 mg IV. May repeat after five minutes with physician order.

Analgesia:
Morphine Sulfate up to 0.1 mg/kg slow IV to a maximum single dose of 10 mg. May repeat every 10 minutes until pain is relieved or respiratory/mental status depression occurs or;

Fentanyl up to 1.0 mcg/kg IN/IM/IV to a maximum single dose of 100 mcg. May repeat dose after 10 minutes with physician order or;

Hydromorphone up to 1.0 mg IV. May repeat dose after ten minutes with physician order.

Key procedural considerations:
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A.  Apply pacing pads, begin pacing at a rate of 60 beats per minute at the lowest available current.
B.  Increase current by 20 milliamp increments until electrical capture.
C.  In the event of electrical capture and no pulses, continue pacing and CPR.

Pediatric pacing is by telemetry physician order only