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ZOLL M Series Biphasic: Pacing Self-Paced Training Module 5

Objectives. At the end of this module the participant can: Define electrical and mechanical captureLocate and use the pacer rate (PPM) dial and the pacer output (milliamps) dialPlace proper pads and electrodes Distinguish the difference between the 3 types of pacing: Demand, Stand-by, Asynchron

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ZOLL M Series Biphasic: Pacing Self-Paced Training Module 5

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    1. ZOLL M Series Biphasic: Pacing Self-Paced Training Module #5

    2. Objectives At the end of this module the participant can: Define electrical and mechanical capture Locate and use the pacer rate (PPM) dial and the pacer output (milliamps) dial Place proper pads and electrodes Distinguish the difference between the 3 types of pacing: Demand, Stand-by, Asynchronous

    3. Transcutaneous pacing is a fast and effective means to stimulate the heart when symptomatic bradycardia or asystole has occurred. When capture is achieved, this means that electrical current, in the form of milliamps, has depolarized the ventricle and caused a ventricular contraction. It is the pacer marker or PPM which is set to determine the paced rate per minute With capture, a change in rhythm will occur on the monitor. The ACLS practitioner should not miss the pulse check that must be done with rhythm change.

    4. Prepare Patient Dry and prepare patient’s chest for application of Stat-Padz AND 3 (or 5) Lead ECG. Both are needed to pace in either Demand or Standby mode. On the rare occasion that asynchronous pacing is used, the ECG will not be applied. Explain to the patient that it feels uncomfortable during the pacing period Realize that you can touch the patient (checking a pulse for instance) when milliamps are discharged

    5. Place Stat-Padz (and electrodes if Demand or Back-up Pacing) Stat-Padz application should be Anterior/Posterior 3-lead ECG electrodes must be placed also Think of 2 pieces of white bread and you are making a myocardial sandwich

    6. Access Pacer (Green) mode The Pacer (Green) mode is accessed by turning the Selector Switch counter-clockwise Milliamps are the type of current which are utilized in this mode No AED capability or ANALYZE button can be used in this mode

    7. Pacer Mode: Rate Dial Pacer markers (PPM) indicate the rate set to attempt to capture the ventricle Default settings of 70 PPM and 0 mA are displayed upon access of Pacer Mode To increase or decrease pacer marker (PPM) turn the Pacer Rate Dial

    8. Pacer Mode: Output Dial Turn the Pacer Output dial to adjust the level of discharged milliamps. If capture is achieved, the PPM will have a wide complex reflecting ventricular contraction following the thin PPM rate marker

    9. Definition of Capture: Electrical and Mechanical Electrical capture: Every PPM (pacer rate indicator) is followed by a larger complex (QRS) which indicates ventricular contraction Mechanical capture: When an associated pulse is created with the electrical capture. Pulse rate should be PPM rate Once electrical and mechanical capture has been confirmed, dial the mA up 10% from capture threshold as a safety margin

    10. Pacing (Green) Mode: Ability to Perform 3 Types of Ventricular Pacing 1.) Demand Pacing: Most frequent form of ventricular pacing. The PPM is set above patient’s rate (or lack thereof) and the Pacer Output dial is turned to increase the mA in attempt to obtain capture and pace the ventricles. 2.) Stand-by Pacing: Setting the PPM and Pacer output at a back-up rate less than a patient’s intrinsic heart rate. The PPM will initially be set above the patients heart rate and pacer output (mA) is increased to achieve 100% capture. The PPM is then decreased to desired rate below the patients intrinsic heart rate. Should the HR drop, the stand-by pacer will initiate impulses and begin to pace.

    11. Pacing (Green) Mode: Ability to perform 3 types of ventricular pacing #3.) Asynchronized Pacing: Rarely used. This form of pacing is performed when no ECG electrodes can be placed due to burns, trauma or interference. The async on/off softkey button is pressed and aysnc mode is displayed. No PPM or electrical capture will be seen on the screen. Mechanical capture will only be proven by palpating a pulse if one is achieved

    12. Pacing (Green) Mode Pause or 4:1 button The 4:1 button may be pushed at anytime to pause the viewing of the milliamps on the screen for 4 beats. This allows for review of the underlying rhythm

    13. This concludes Module #5 Pacing Continue review of further modules required by your facility

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