CPR Renewal
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New NRP Class
Transvenous Pacing
September 16, 2008
For ACLS purposes, we are primarily concerned with two basic types of pacing. The first, transcutaneous pacing, is an emergent procedure which uses 2 gel pads. One is placed at the 5th intercostal space mid-clavicular on the left side of the anterior chest wall, and the other in between the backbone and shoulder blade on the left side of the back. The electricity travels through the pads and innervates the heart. This form of pacing is temporary. It is especially uncomfortable for the patient, and therefore should only be used as a means of maintaining stability in the bradycardic patient while attempting other interventions, such as drug therapy, or preparing for a more permanent transvenous pacemaker which causes no pain.
Types of Rhythms Where Pacing Is Indicated
• Bradycardias that are unresponsive to drug therapy or are symptomatic
• 2nd degree heart block type II
• 3rd degree heart block
Clinical Note:
Atropine may be given to 2nd degree type II heart block or a narrow complex 3rd degree heart block as a trial but, when detected, the American Heart Association ACLS guidelines recommend that these dysrhythmias be managed by immediate application of the transcutaneous pacer and close observation of the patient for any signs of hemodynamic instability, e.g., shortness of breath – hypotension – altered level of consciousness – chest pain – pallor – nausea & vomiting – profuse sweating. If unstable and in 2nd degree heart block type II or 3rd degree heart block, then the pacer should be used to correct the rate only until transvenous pacing can be accomplished by a qualified person.
Remember from earlier in the reading that if a patient is bradycardic and hemodynamically unstable, as described in the previous paragraph, then transcutaneous pacing should be considered as a first line treatment.
Setting a transcutaneous pacemaker will be discussed in the electrical therapy station on day 1 of ACLS
Three Basic Rhythms
There are 3 categories of abnormal rhythms: too fast, too slow or none. Patients with any dysrhythmia may be stable, unstable or in cardiac arrest. Recognizing which type of patient you have will decide your treatment choices: medicine, electrical, and/or mechanical (BLS).
Too Fast
The first rhythm is too fast. Our goal is to slow it down. We have two methods to slow down a rhythm: electrical therapy and/or medicine. If the patient is hemodynamically stable, pharmacology should be the first line treatment. If our patient were hemodynamically unstable, synchronized cardioversion should be the first line treatment.
Too Slow
The second rhythm is too slow. Our goal is to speed it up. We have two methods of speeding up a rhythm: electrical therapy and/or medicine. If the patient is hemodynamically stable, pharmacology should be the first line treatment. If our patient were hemodynamically unstable, transcutaneous pacing should be the first line treatment.
None
Ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity and asystole are the dysrhythmias associated with cardiac arrest. As these are lethal dysrhythmias, management must be quick and aggressive.
Palm Beach ACLS Classes (West Palm Beach)
July 28, 2008
West Palm Beach
Palm Beach Staffing
1261 South Congress Ave
West Palm Beach, FL
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One Day Class
Saturday
9:00 am – 5:30 pm
July 12
August 9
September 13
October 11
November 8
December 13
January 10, 2009
Register Online for 1-day ACLS Class
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{column2}
Two Day Class
Saturday
9:00 am – 12:40 pm
Sunday
9:00 am – 5:15 pm
July 12 – 13
August 9 – 10
September 13 – 14
October 11 – 12
November 8 – 9
December 13 – 14
January 10 – 11, 2009
Register Online for 2-day ACLS Class
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Palm Beach ACLS Class (Boca Raton)
July 28, 2008
Boca Raton
West Boca Medical Center
21644 State Road 7
Education Center North
Boca Raton, FL
{column1}
One Day Class
Saturday
9:00 am – 5:30 pm
July 26
August 23
September 27
October 25
November 22
December 27
January 24, 2009
Register Online for 1-day ACLS Class
{/column1}
{column2}
Two Day Class
Saturday
9:00 am – 12:40 pm
Sunday
9:00 am – 5:15 pm
July 26 – 27
August 23 – 24
September 27 – 28
October 25 – 26
November 22 – 23
December 27 – 28
January 24 – 25, 2009
Register Online for 2-day ACLS Class
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Ft. Lauderdale ACLS Class (North Broward)
July 28, 2008
North Broward
Keiser University
1500 NW 49 Street
Ft. Lauderdale, FL
(Please go to the front desk for classroom assignment)
One Day Class
Wednesday
9:00 am – 5:30 pm
July 22
August 19
September 23
October 21
November 18
December 16
January 20, 2009
Register Online for 1-day ACLS Class
{/column1}
{column2}
Two Day Class
Wednesday
9:00 am – 12:40 pm
Thursday
9:00 am – 5:15 pm
July 22 – 23
August 19 – 20
September 23 – 24
October 21 – 22
November 18 – 19
December 16 – 17
January 20 – 21, 2009
Register Online for 2-day ACLS Class
{/column2}
Ft. Lauderdale ACLS Class (West Broward)
July 28, 2008
West Broward
Plantation General Hospital
Medical Office Building II
4101 N.W. 3rd Court, Suite #7
Plantation, FL
{column1}
One Day Class
Saturday
9:00 am – 5:30 pm
July 9
August 6
September 10
October 8
November 5
December 10
January 7, 2009
Register Online for 1-day ACLS Class
{/column1}
{column2}
Two Day Class
Saturday
9:00 am – 12:40 pm
Sunday
July 9 – 10
August 6 – 7
September 10 – 11
October 8 – 9
November 5 – 6
December 10 – 11
January 7 – 8, 2009
Register Online for 2-day ACLS Class
{/column2}
