Transcutaneous pacing (TCP) with a Lifepak 12

Image credit: Physio-Control

 

I discovered an interesting quirk about the Lifepak 12 the other day.

I'm sure many of you have been told (as I had been told) that the Lifepak 12 cannot perform TCP unless the limb lead electrodes are attached. There is a caveat to this (reference page 4-18 in the Operations Manual – this is a PDF file so "right-click" the link and select "save as"). If you are performing TCP in demand mode (even if you have it set well below the patient's intrinsic rate and no pacing is being delivered) as soon as the monitor detects "leads off" the monitor will deliver TCP at a fixed rate until the leads are replaced or the pacer is turned off.

For example, say you have a patient with atrial fibrillation and a slow ventricular response of 50 BPM whose ventricular response occasionally drops down to 20 (with 3 – 6 second asystolic pauses during which time the patient loses consciousness and appears peri-arrest). You apply the combo-pads and set the demand pacer for 40 PPM @ 130 mA so that the patient’s heart rate cannot drop below 40 (assuming capture is achieved with 130 mA). The patient’s heart rate stays above 40 so no pacing is delivered.

At the hospital, the nurses (through no fault of their own) remove the ECG leads to switch the patient to their own Lifepak 20. What happens? Answer: The Lifepak 12 delivers fixed rate pacing at 40 PPM @ 130 mA through the combo-pads until the leads are replaced or the pacer is turned off. Not a big deal, just something to be aware of. This is not a device malfunction.

See also:

Transcutaneous pacing (TCP) – The problem of false capture

Using capnography to confirm capture with transcutaneous pacing (TCP)

58 year old male CC: Unconscious (Transcutaneous pacing failure in the setting of hyperkalemia)

Transcutaneous pacing (TCP) for asystole

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Comments
Nick
100 yof CC: Rib pain and intermittent spasms
Can't be a potassium imbalance. The TW's wouldn't change and then change back. If it was coronary spasm, I would expect some ST segment elevation. The TW'S are also not hyperacute (peaked). Does she wear some sort of electronic stimulator?
2014-11-19 01:05:43
Anterior T wave inversions and PE. | EMS 12 Lead
Not just S1Q3T3: Look at the other 10 leads!
[…] Last week, I described the case of a middle-aged male with a vague history of heart failure who had been having progressive shortness of breath for 4-5 days. On the day he called 911, he had been walking a short distance when he syncoped. EMS obtained an ECG: […]
2014-11-18 18:33:47
Christine
100 yof CC: Rib pain and intermittent spasms
I believe this may be coronary artery vasospasm.
2014-11-18 11:02:45
Ian Fudge
What it Looks Like: Cardiac Arrest
this is really interesting because something similar happened to a patient as I sat them up in bed after delivering them to a community hospital in fact I even turned to his son and said "does dad suffer with epilepsy?" And then turned back and realised he wasn't breathing
2014-11-18 07:59:13
Dustin
100 yof CC: Rib pain and intermittent spasms
External interference? Something like a bladder stimulator or spinal stimulator.
2014-11-18 00:32:54

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