Table of Contents Setting upPacing Before you start Indications: haemodynamically unstable bradycardia (unresponsive to atropine); complete heart block; Mobitz type II second-degree heart block when haemodynamically unstable; sudden witnessed asystole secondary to cardioversion/drugs/conduction defect; override pacing of tachycardias refractory to drugs and cardioversion (rarely used) Setting up Anaesthetist must be present to sedate patient (most patients cannot tolerate pacing >50mA)Apply 3-lead cardiac monitoring (clockwise from right arm Ride Your Green Bicycle) and connect lead to external cardiac monitor or defibrillator machineRed: anterior aspect of right shoulderYellow: anterior aspect of right shoulderGreen: left anterior superior iliac spineBlack: not present on defibrillation machineApply defibrillator pads (in AP position) after shaving chest if required‘Right’ pad: place longitudinally on left sternal edge‘Left’ pad: place longitudinally on left paraspinal muscles (in line with anterior pad)Connect pads lead to defibrillator machineSet defibrillator machine monitoring trace to ‘pads’ Pacing Set defibrillator to pacing modeSet onscreen pacing rate (default usually ̴ 70bpm) and energy (default starting energy usually ̴ 30mA)Click onscreen start pacing buttonObserve the monitor to see if QRS complexes follow every pacing spike – if not, increase the energy until they do – ‘electrical capture’ (usually occurs at 50-100mA)Next check the patients pulse corresponds to the induced QRS complexes – ‘mechanical capture’Seek senior help and definitive management Note you can touch the patient during. Pacing set up