UTSW/BioTel EMS TRAINING BULLETIN
September 2014

EMS TB 14-003 External Cardiac Pacing   (PDF Here)

Purpose:
External cardiac pacing is a procedure that should be used for patients with SYMPTOMATIC bradycardia which is defined as a heart rate less than 60 with signs of inadequate perfusion. Such patients are usually older and have a history of cardiac problems.

Training Points:

  1. External cardiac pacing SHOULD NOT be INITIALLY utilized for young (less than 40 years old) patients who were previously healthy and who are initially found to be suffering from a seizure or possible drug overdose. Should such patients become bradycardic, paramedics should assume that they are hypoxic or are about to suffer a RESPIRATORY ARREST. Paramedics should focus their efforts on definitively managing the patient's airway with aggressive supplemental oxygen and bag-valve-mask, King tube or endotracheal intubation, as indicated. Only AFTER the airway is definitely managed should external cardiac pacing be considered in these patients and only if they remain bradycardic with signs of inadequate perfusion following definitive airway management.
  2. Paramedics should be familiar with the UTSW/BioTel Bradycardia Guideline for Treatment.  In addition to hypoventilation and imminent respiratory arrest as a cause of the bradycardia, paramedics must consider Beta Blocker or Calcium Channel Blocker overdose.
  3. If you have any questions about the appropriate management of a patient with symptomatic bradycardia, contact BioTel immediately.

See also:

Bradycardia Guideline

Poisoned Patient and Overdose Guideline