Electromechanical Dissociation / TVP

This patient suffered a brady-asystolic arrest and a transvenous pacer was placed in the emergency department.

We are accustomed to relying on the monitor’s ECG tracing to determine heart rate; however, a good pulse oximeter waveform better reflects the number of perfusing beats. Note the heart rate, as measured by the pulse ox, is reported in purple in the upper-right corner of the monitor. At this point we had achieved electrical capture but not mechanical capture.

Watching the pulse oximetry graph is a slick way to guide pacemaker insertion. Cardiac sonography and placing a finger on the patient’s neck to assess the pulse are alternatives.


Strayer Transvenous Pacemaker Instruction Sheet