Revisiting Transcutaneous Cardiac Pacing

“Transcutaneous cardiac pacing is an effective procedure for patients experiencing unstable bradycardia.” Or is it? If you’ve read Tom’s introduction to the subject of false capture you’re already ahead of the game. We’ve shown case after case of unstable bradycardia patients receiving ineffective transcutaneous pacing due to a lack of capture. In each case, phantom pacing impulses are interpreted by the paramedic as electrical capture. Typically, this is confirmed by an improvement in other vital signs, such as mental status or blood pressure. If I was being shocked 70 to 80 times a minute, you would likely notice an increase in my blood pressure too! So why do we fail to recognize true electrical capture? Are paramedics just that bad at ECG interpretation? Absolutely not. This is a failure on the educational side. We’ve conditioned paramedics to fail by showing them unrealistic ECG strips time and time again. We tell them to start at unrealistically low outputs and ask that they gingerly increase the output. We scare them that high outputs are painful. Check out the ACLS standard for “electrical capture”: That looks pretty simple to me! 60 mA? Awesome. Another SAVE! How about what a rhythm generator shows to a real live cardiac monitor during training? One spike, no complex. Easy as pie, we need more milliamps. We’ve got this, right? That is really, really easy to see. Except that’s not what the pro...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: ems-topics patient-management appropriate T-wave discordance Christopher Watford data quality ECG education paced rhythm Paramedic phantom QRS complexes transcutaneous pacing Source Type: research