Examples of problems that can falsely inhibit the external pacer include seizures, road noise, electromagnetic interference, or an implanted pacemaker which is producing electrical spikes without capture of the myocardial tissue. It is interesting to note that myocardial depolarization can be initiated with slightly less current if the apex of the heart is connected to the negative electrode of the pacing generator. This is usually true for both endocardial and external pacing, but is particularly important in external pacing because proper pad placement can achieve capture at a lower level of energy, which is more comfortable for the patient. Although external pacing is uncomfortable, there are several techniques to minimize the discomfort. The first and most important is to explain to the patient that this will be uncomfortable and that it is absolutely necessary to help them.
Pad placement is critical, apply as illustrated.
Remember that if your placement is too low, you may have excessive diaphragmatic stimulation and could interfere with respirations. Placement that is too high or lateral will result in failure to capture or capture only at a very high current setting. The conductive part of the pad must not be on a break in the skin or on the nipple. If chest hair is excessive, then clip the hair with scissors but do not nick the skin. Do not scrub or abrade the skin.