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.

• 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

• FROM ANY DIRECTION: I-95 to Palmetto Park Road Exit, go east, heading immediately into far left lane to the traffic light. Make u-turn at the light, and go immediately into far right turning lane .Make a very quick right turn. Turns left, then make a sharp right into the interstate Plaza. Go straight and proceed to the back of the building, See a sign for parking. Follow sigh to the ramp for the parking garage. Park on the first or second level. Go to the first level. Go west, and follow the path across the street where you’ll see Hospice by the Sea’s West building, Main Entrance is on your left.
  

• 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.

• FROM THE EAST: Take I-95 to Commercial Blvd (Exit 32). Go west for approximately one mile.  Turn left at NW 17th Way (Spectrum Way).  Keiser University will be on your left.  Please park on the unpaved lot behind the building.
• FROM THE WEST: Take the Turnpike to Commercial Blvd (Exit 62).  Go east for approximately three miles. Turn right at NW 17th Way (Spectrum Way).  Keiser University will be on your left. Please park on the unpaved lot behind the building.

• FROM ANY DIRECTION: Take the Turnpike to Eureka Drive (SW 184 Street) and go east to
  US-1.  Proceed North to SW 174 Street and Gramercy Park is on the right facing US 1. It is a four story, pastel colored building surrounded by a black iron ornamental fence.  Pull up to the gate on
  US-1 and it will open automatically. The classroom is located on the first floor in the education
  center.

Medical Office Building
11760 SW 40th  Street (Bird Road)
Miami, FL

• FROM THE NORTH OR SOUTH: Take I-95 or Turnpike to the Golden Glades Interchange. Exit 441 North. Building will be on the right, after passing Miami Gardens Drive.
• FROM THE WEST: Take SR 826 East exit 441 North. The Building will be on the right after passing Miami Gardens Drive.
• FROM THE EAST: Exit Miami Gardens Drive west to NW 2nd ave make a right Building will be in the right.

Dade County Locations

Nursing Unlimited Headquarters (directions)
Kendall Regional Medical Center (directions) (map)
Gramercy Park Nursing Center (directions) (map)

Broward County Locations

Keiser University (directions) (map)
Plantation General Hospital (directions) (map)

Palm Beach County Locations

Hospice by the Sea (directions) (map)
West Boca Medical Center (directions) (map)
Palm Beach Staffing (directions (map)