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External Pacing

Clinical Indications: Last Updated 02/2009

    Patients with symptomatic bradycardia (less than 60 per minute) with signs and symptoms of
    inadequate cerebral or cardiac perfusion such as:

    -Chest Pain
    -Pulmonary Edema
    -Altered Mental Status, Confusion, etc.
    -Ventricular Ectopy
    -Asystole, pacing must be done early to be effective.
    -PEA, where the underlying rhythm is bradycardic and reversible causes have been treated.


    1. Attach standard four-lead monitor.

    2. Apply defibrillation/pacing pads to chest.

    3. Consider the use of sedation or analgesia if patient is uncomfortable.

    4. Rotate selector switch to pacing option.

    5. Adjust heart rate to 70 BPM for an adult and 100 BPM for a child.

    6. Note pacer spikes on EKG screen.

    7. Slowly increase output until capture of electrical rhythm on the monitor.

    8. If unable to capture while at maximum current output, stop pacing immediately.

    9. If capture observed on monitor, check for corresponding pulse and assess vital signs.

    10. Document the dysrhythmia and the response to external pacing with ECG strips in the

Competency Based Skill Requirements:

    Maintain knowledge of the indications, contraindications, technique, and possible
    complications of the procedure. Assessment of this knowledge may be accomplished via
    quality assurance mechanisms, classroom demonstrations, skills stations, or other
    mechanisms as deemed appropriate by the local EMS System. Assessment should include
    direct observation at least once per certification cycle.

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