Antero-lateral infarct To Arrest.

[Tigger]

You can pace effectively without A/P pad placement and a glance at the pulse ox pleth will indicate capture or not. Those things aside, if there are folks that are not trained well in external pacing, how well trained can they be in treating a full arrest?

Pace when indicated.

Will find it in a bit, but there’s some research suggesting that folks of all levels are pretty awful at recognizing mechanical capture.

 

[E tank]

Will find it in a bit, but there’s some research suggesting that folks of all levels are pretty awful at recognizing mechanical capture.

I'd be interested in that, thanks. Impossible for me because I most always have an arterial line. There's either a waveform or there isn't. I suspect motion artifact or peripheral perfusion issues can interfere with the pulse ox, but I wouldn't think that would be common enough for universal 'awfulness' at recognizing capture. Do send that along.

 

[Aprz]

Me: *quick glance at pleth wave*

Perhaps equipment matters, but pulse ox has failed me once and anteroapical placement has failed me 100%.

 

[Tigger]

I'd be interested in that, thanks. Impossible for me because I most always have an arterial line. There's either a waveform or there isn't. I suspect motion artifact or peripheral perfusion issues can interfere with the pulse ox, but I wouldn't think that would be common enough for universal 'awfulness' at recognizing capture. Do send that along.

I cannot find the research I was looking for, it used to be referenced in this article I had saved. https://www.ems12lead.com/post/transcutaneous-pacing-tcp-the-problem-of-false-capture

In any case some good points that pacing is harder then saying "pace em." Pulse checks are not very helpful due to skeletal muscle contractions. Pulse ox might not be accurate. Capnography might be helpful but I haven't had much luck.

 

[E tank]

Me: *quick glance at pleth wave*
Perhaps equipment matters, but pulse ox has failed me once and anteroapical placement has failed me 100%.

So, looking at that strip, it's evident when a pulse does occur after a pacer spike (or native beat) and when one doesn't. Also looks like that patient is clearly benefiting from pacing if the pulse wave conduction is any indicator.

I agree looking at the ecg alone, that isn't evident at all, but that shouldn't be surprising, nor should the ecg necessarily be the last word on whether you're getting adequate capture in the settings that you guys work in.

Like I said, pace when indicated. Doesn't mean don't do anything else.

I cannot find the research I was looking for, it used to be referenced in this article I had saved. https://www.ems12lead.com/post/transcutaneous-pacing-tcp-the-problem-of-false-capture

In any case some good points that pacing is harder then saying "pace em." Pulse checks are not very helpful due to skeletal muscle contractions. Pulse ox might not be accurate. Capnography might be helpful but I haven't had much luck.

Thanks for posting that. I think the title should be changed to "The problem of failure to trouble shoot false capture"

He doesn't mention trying to auscultate a blood pressure. Lot's of information from that if successful.