ZOLL E Series Monitor Defibrillator Rev D - Manual (Page 217)

NonInvasive Temporary Pacing (Pacer Version Only)
9650-1210-01 Rev. R 9-3
by increasing the pacer output (mA) until every pacing
marker is immediately followed by a wide QRS complex.
Note that changing ECG leads and size can sometimes
be helpful in determining capture.
Mechanical Capture
Mechanical capture is indicated when the patient’s pulse
approximates the displayed pace rate.
Because pacing stimuli generally causes muscular
contractions that can be mistaken for a pulse, you should
never take a pulse on the left side of the body. Similarly,
pectoral muscle contractions due to pacing stimuli do not
indicate mechanical capture. To avoid mistaking
muscular response to pacing stimuli for arterial
pulsations, use ONLY the following locations for taking
palpating pulse during pacing:
• Femoral artery
• Right brachial or radial artery.
6 Determining Optimum Threshold
The ideal output current is the lowest value that
maintains mechanical capture. This is usually about 10%
above threshold. Threshold is the minimum current that
must be exceeded to begin producing a given effect, in
this case ventricular capture. Typical threshold currents
are between 40 and 80 mA. Location of the MFE Pads
affects the current required to obtain ventricular capture.
The MFE Pad placement that offers the most direct
current pathway to the heart while avoiding large chest
muscles usually produces the lowest threshold. Low
stimulation currents produce less skeletal muscle
contraction and are better tolerated.
Checking Underlying Patient Rhythm with 4:1 Mode
Press and hold the 4:1 button to temporarily withhold
pacing stimuli thereby allowing you to observe the
patient’s underlying rhythm and morphology. When
depressed, this button causes pacing stimuli to be
delivered at ¼ the indicated ppm setting.
Clearing Pacing Alarms
The messages CHECK PADS and POOR PAD
CONTACT are alternately displayed on the screen and
an audible alarm sounds if the unit is attempting to
deliver pacing therapy and one of the following
conditions is true:
• The MFE cable is not connected to the device.
• The MFE cable is defective.
• MFE Pads are not connected to the Multi-Function
cable.
• MFE Pads are not making good skin contact.
The alarm continues to sound until the Clear Pace
Alarm softkey is pressed.
Special Pacing Applications
Noninvasive Temporary Pacing may be performed in the
Cardiac Cath Lab, either for emergency pacing or in
standby mode. Radiolucent stat-padz are available to
facilitate pacing in X-ray and fluoroscopic applications.
Noninvasive Temporary Pacing may also be performed
in the operating room using sterile stat-padz.
Observe the device carefully for evidence of proper
operation.
Standby Pacing
For certain patients at risk of developing symptomatic
bradycardia, it may be advisable to use the unit in
standby mode. When used in standby mode, the unit
automatically provides a pacing stimulus whenever the
patient’s heart rate drops below a predetermined level.
Patient’s ECG must be monitored using ECG leads and
patient cables for this application. To use the device in
standby mode:
1. Establish effective pacing (see instructions on previ-
ous pages). Note the mA output at capture and run
an ECG strip to document ECG morphology during
capture.
2. Set the mA output 10% higher than the minimum mA
output necessary to effect consistent ventricular
capture.
3. Turn the pacing rate (ppm) below the patient’s heart
rate. This suppresses pacing unless the patient’s own
0!#%2
2!4%
PPM
0!#%2
/54054
M!
CAUTION
Under certain conditions it may not be possible to
properly monitor or pace while electrosurgical
apparatus is operating.
PACE
Clear
Pace
Alar m
00:01
Async
Pacing
On/Off
50 mA 70 PPM
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
ECG
CHECK PADS