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Pacing in ED is not technically difficult. Below is a presentation from today’s teaching.
The decision to commence pacing is challenging and can be a cause for hesitation.
Failure of chronotropic therapy and an inadequately perfusing rhythm e.g.bradycardia, complete heart block should prompt initiation of treatment.
Transvenous pacing is the gold-standard but requires a skill set not always available.
Follow the link to a power point presentation from today’s teaching with an overview of pacemakers and pacing in the ED. At the end are links which I have included below for convenience – or if you want more detail. Send in your comments as usual.
This case was referred from a small rural hospital with limited facilities to ARV on the weekend.
45 year old male who re-presented with epigastric pain having been discharged 48hrs earlier with a diagnosis of GORD and treated with a proton pump inhibitor and antacids.
His pain got worse and his ECG now showed this:
He was thrombolysed and had a brief run of VF which he was successfully defibrillated from and his ECG pre-transfer was almost back to normal.
You arrive for handover, a 52 yr old lady awaiting ablation for WPW has presented with palpitations sits in resus. Stable.
What’s the rhythm?
She slows with flecainide.
Before reverting to SR
Her last ECG, just before leaving for inpatient ablation reveals the ‘delta’ wave in V3 and V4 – also develops T wave inversion in V1-3.