ZOLL E Series Monitor Defibrillator Rev R - Manual (Page 16)

E Series Operator’s Guide
1-8 9650-1210-01 Rev. R
External Pacemaker Function (Pacer
version only)
Some E Series products may include an optional
transcutaneous demand pacemaker consisting of a
pulse generator and ECG sensing circuitry. Non-invasive
Transcutaneous Pacing (NTP) is an established and
proven technique. This therapy is easily and rapidly
applied in both emergency and non-emergency
situations when temporary cardiac stimulation is
indicated.
Proper operation of the device, together with correct
electrode placement, is critical to obtaining optimal
results. Every operator must be thoroughly familiar with
these operating instructions.
The output current of the pacemaker is continuously
variable from 0 to 140 mA. The rate is continuously
variable from 30 to 180 pulses per minute (ppm).
The pacing output pulse is delivered to the heart by
specially designed ZOLL MFE Pads placed on the back
and the precordium.
The characteristics of the output pulse, together with the
design and placement of the electrodes, minimize
cutaneous nerve stimulation, cardiac stimulation
threshold currents, and reduce discomfort due to skeletal
muscle contraction.
The unique design of the E Series products allow clear
viewing and interpretation of the electrocardiogram
(ECG) on the display without offset or distortion during
external pacing.
Intended Use — Pacemaker
This product may be used for temporary external cardiac
pacing in conscious or unconscious patients as an
alternative to endocardial stimulation.
Note: This device must not be connected to internal
pacemaker electrodes.
The purposes of pacing include:
• Resuscitation from standstill or bradycardia of
any etiology
Noninvasive pacing has been used for resuscitation
from cardiac standstill, reflex vagal standstill, drug
induced standstill (due to procainamide, quinidine,
digitalis, b-blockers, verapamil, etc.) and unexpected
circulatory arrest (due to anesthesia, surgery,
angiography, and other therapeutic or diagnostic
procedures). It has also been used for temporary
acceleration of bradycardia in Stokes-Adams disease
and sick-sinus syndrome. It is safer, more reliable,
and more rapidly applied in an emergency than
endocardial or other temporary electrodes.
• As a standby when standstill or bradycardia
might be expected
Noninvasive pacing may be useful as a standby
when cardiac arrest or symptomatic bradycardia
might be expected due to acute myocardial infarction,
drug toxicity, anesthesia or surgery. It is also useful
as a temporary treatment in patients awaiting
pacemaker implants or the introduction of
transvenous therapy. In standby pacing applications,
noninvasive pacing may provide an alternative to
transvenous therapy that avoids the risks of
displacement, infection, hemorrhage, embolization,
perforation, phlebitis and mechanical or electrical
stimulation of ventricular tachycardia or fibrillation
associated with endocardial pacing.
• Suppression of tachycardia
Increased heart rates in response to external pacing
often suppress ventricular ectopic activity and may
prevent tachycardia.
Pacemaker Complications
Ventricular fibrillation does not respond to pacing and
requires immediate defibrillation. Therefore, the patient’s
dysrhythmia must be determined immediately, so that
you can employ appropriate therapy. If the patient is in
ventricular fibrillation and defibrillation is successful but
cardiac standstill (asystole) ensues, you should use the
pacemaker.
Ventricular or supraventricular tachycardias may be
interrupted with pacing but in an emergency or during
circulatory collapse, synchronized cardioversion is faster
and more certain. (See “Synchronized Cardioversion” on
page 6-1).
Electromechanical dissociation may occur following
prolonged cardiac arrest or in other disease states with
myocardial depression. Pacing may then produce ECG
responses without effective mechanical contractions,
and other treatment is required.
Pacing may evoke undesirable repetitive responses,
tachycardia, or fibrillation in the presence of generalized
hypoxia, myocardial ischemia, cardiac drug toxicity,
electrolyte imbalance, or other cardiac diseases.
Pacing by any method tends to inhibit intrinsic
rhythmicity. Abrupt cessation of pacing, particularly at
rapid rates, can cause ventricular standstill and should
be avoided.
Noninvasive Temporary Pacing may cause discomfort of
varying intensity, which occasionally can be severe and
preclude its continued use in conscious patients.
Similarly, unavoidable skeletal muscle contraction may
be troublesome in very sick patients and may limit
continuous use to a few hours. Erythema or hyperemia
of the skin under the MFE Pads often occurs; this effect
is usually enhanced along the perimeter of the electrode.