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Pacing in ED – permanent and temporary

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.

Pacing in ED


Epigastric pain in a young male – why we repeat ECGs.


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 presenting ECG was as follows: presenting ECG


His pain got worse and his ECG now showed this:

23 minutes later

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.

1hr post thrombolysis


Broad complex tachycardia

You arrive for handover, a 52 yr old lady awaiting ablationĀ for WPW has presented with palpitations sits in resus. Stable.

What’s the rhythm?

52 yr old female with palpitations

She slows with flecainide.

8 minutes post treatment

Before reverting to SR

21 minutes post treatment

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.

Pre- transfer

First post

This weeks topic was ECG interpretation in AMI. The focus was on detecting STEMI and some other forms of proximal left coronary artery disease of note.

Follow the link to a power point presentation from last week.