An 82-year-old man with a permanent pacemaker presents to a regional ED, triage category 1, after collapse. BP 68/44, HR 28, cool peripheries. ECG

Question

An 82-year-old man with a permanent pacemaker presents to a regional ED, triage category 1, after collapse. BP 68/44, HR 28, cool peripheries. ECG shows pacing spikes not followed by QRS complexes. Potassium is 4.8 mmol/L and bedside glucose is normal. What is the most important immediate action?

Accepted Answer

Commence transcutaneous pacing

Answer

Administer oral digoxin

Answer

Arrange elective pacemaker clinic review

Answer

Give IV metoprolol

Answer

Observe until device interrogation

Pacemaker failure with bradycardic shock — ACEM Fellowship MCQ

An 82-year-old man with a permanent pacemaker presents to a regional ED, triage category 1, after collapse. BP 68/44, HR 28, cool peripheries. ECG shows pacing spikes not followed by QRS complexes. Potassium is 4.8 mmol/L and bedside glucose is normal. What is the most important immediate action?