Pediatric External Pacing
1. Initial rhythm
2. Pacer function activated with sense markers appearing. The default pacing settings on the Lifepak 12 is a rate of 60 beats per minutes and a demand mode. The milliamps are at zero, so no pacer spikes are seen.
3. AHA recommends a pacing rate of 100 beats per minute on pediatric patients. The pacing rate has been increased from the default rate of 60 to 100 beats per minute and the milliamps have been increased to maximum output. You want to gain electrical capture as fast as possible with pediatric patients. Recall that pediatric patients can deteriorate to cardiac arrest very quickly.
4. The maximum milliamp setting on the Lifepak 12 is 200 milliamps. On this strip I have already begun to decrease the milliamps. The milliamps are now at 155 mA with good electrical capture.
5. I am continuing to decrease the milliamps downward (now 100 mA) and continue to maintain electrical capture of the myocardium.
6. I have decreased the milliamps to 65 mA and have lost electrical capture. This is below my pacing threshold, or the minimum amount of current needed to obtain electrical capture. Now, I want to increase my milliamps back above the pacing threshold. (Notice the reappearance of the sense markers above the R waves with loss of electrical capture)
7. My pacing threshold is about 70 milliamps, so I increased my milliamp setting slightly above the pacing threshold in order to maintain electrical capture. Always assess the patient for good mechanical capture: palpable pulse that matches the pacing rate, improved hemodynamics,improved skin temperature and color, improved pulse oximetry, improved level of consciousness.
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| Complete heart block |
2. Pacer function activated with sense markers appearing. The default pacing settings on the Lifepak 12 is a rate of 60 beats per minutes and a demand mode. The milliamps are at zero, so no pacer spikes are seen.
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| Complete heart block with sensing markers for external pacing |
3. AHA recommends a pacing rate of 100 beats per minute on pediatric patients. The pacing rate has been increased from the default rate of 60 to 100 beats per minute and the milliamps have been increased to maximum output. You want to gain electrical capture as fast as possible with pediatric patients. Recall that pediatric patients can deteriorate to cardiac arrest very quickly.
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| Complete heart block with external pacing |
4. The maximum milliamp setting on the Lifepak 12 is 200 milliamps. On this strip I have already begun to decrease the milliamps. The milliamps are now at 155 mA with good electrical capture.
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| Complete heart block with external pacing |
5. I am continuing to decrease the milliamps downward (now 100 mA) and continue to maintain electrical capture of the myocardium.
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| Complete heart block with external pacing |
6. I have decreased the milliamps to 65 mA and have lost electrical capture. This is below my pacing threshold, or the minimum amount of current needed to obtain electrical capture. Now, I want to increase my milliamps back above the pacing threshold. (Notice the reappearance of the sense markers above the R waves with loss of electrical capture)
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| Complete heart block with loss of electrical capture |
7. My pacing threshold is about 70 milliamps, so I increased my milliamp setting slightly above the pacing threshold in order to maintain electrical capture. Always assess the patient for good mechanical capture: palpable pulse that matches the pacing rate, improved hemodynamics,improved skin temperature and color, improved pulse oximetry, improved level of consciousness.
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| Complete heart block with external pacing |
This would be a very valuable presentation...if it were correct. The strips do not correspond with the text, you did not explain that the sense markers are what is indicating electrical capture...
ReplyDeletePlease indicate which strips do not correspond with the text. Yes, good point! The reappearance of the sense markers in strip 6 are indicative of a loss of electrical capture. These strips were made using a Lifepac 12. Do you happen to know if this same sense marker functionality is present on other brands of defibrillator/monitor. Thanks for your feedback. Always valuable!
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