CPR Renewal
Online Training
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 Location – West Palm Beach
August 25, 2008
West Palm Beach
Palm Beach Staffing
1261 South Congress Ave
West Palm Beach, FL
- FROM THE SOUTH: Take I-95 to the Forest Hill Blvd West exit. Go West to Congress Ave and turn right (North) to NW Collin Drive. Make a U-turn on Collin Drive the building will be on your right hand side.
- FROM THE NORTH: Take I-95 to Southern Boulevard . West exit. Go West to Congress Ave. and turn left. Building will be on the right side past Collin Drive.
- FROM THE TURNPIKE: Take Turnpike to Southern Boulevard . East exit. Go East to Congress Ave. and turn right. Building will be on the right side past Collin Drive.
Classes offered at this location
- CPR Renewal
- CPR Skills Assessment
- ACLS
- PALS
- AIDS/OSHA/TB – BBP
- Domestic Violence
- Prevention of Medical Errors
- Phlebotomy
- Starting and Maintaining IV Certification
- PICC Line Insertion Class
Palm Beach Location – Boca Raton West
August 25, 2008
Boca Raton
West Boca Medical Center
21644 State Road 7
Boca Raton, FL FROM ANY DIRECTION: Take the Turnpike or I-95 to Glades Road Exit, and go West to 441, head South and the medical center will be on the left. The Education Center is located next to the Birthcare Pavilion entrance.
Palm Beach Location – Boca Raton East
August 25, 2008
Boca Raton
Hospice by the Sea
1531 West Palmetto Park Road
Boca Raton, FL
- FROM ANY DIRECTION: Take I-95 to Palmetto Park Road Exit, and go East and the medical center will be on the left
Broward Location – Plantation
August 25, 2008
West Broward
Plantation General Hospital
401 NW 42 Avenue
Plantation, FL
- FROM ANY DIRECTION: The hospital is located West of 441 (also called State Road 7) between Broward and Sunrise Boulevards. Take any major road to 441 and when you get to Broward Blvd. or Sunrise Blvd., follow the Blue Hospital roadway signs. Parking is in the visitor’s lot.
Plantation General Hospital
Medical Office Building II
4101 NW 3rd Court
Plantation, FL
- FROM THE SOUTH: Take I-95 to the Broward Blvd. West exit. Go West to 441 (State Road 7) and turn right (North) to NW 3rd Court. Turn left (West) on NW 3rd Court. The Medical Office Building II is the 1st building on your right. Parking is available underneath the building.
- FROM THE NORTH: Take I-95 to the Sunrise Blvd. West exit. Go West to 441 (State Road 7) and turn left (South) to NW 3rd Court. Turn right (West) on NW 3rd Court. The Medical Office Building II is the 1st building on your right. Parking is available underneath the building.
- FROM ANY OTHER DIRECTION: Take 441 (State Road 7) to North Hospital Drive (NW 4th Street). Turn left (West) on North Hospital Drive. The Medical Office Building II is the 1st building on your left. Parking in under the building.
