{"id":2530,"date":"2021-11-19T14:48:33","date_gmt":"2021-11-19T22:48:33","guid":{"rendered":"https:\/\/www.nicolekupchikconsulting.com\/news\/?p=2530"},"modified":"2024-12-06T09:36:47","modified_gmt":"2024-12-06T17:36:47","slug":"pacing","status":"publish","type":"post","link":"https:\/\/www.nicolekupchikconsulting.com\/news\/pacing\/","title":{"rendered":"Pacing"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Indications for Emergent Pacing<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"339\" height=\"256\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture1.jpg\" alt=\"\" class=\"wp-image-2531\" srcset=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture1.jpg 339w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture1-300x227.jpg 300w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture1-270x204.jpg 270w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture1-80x60.jpg 80w\" sizes=\"auto, (max-width: 339px) 100vw, 339px\" \/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Over the next few weeks, we are going to be chatting all things related to emergent pacing!! When it comes to emergently pacing your patient, it can be a bit intimidating&#8230;but we want to break it down and make it EASY for you. Let\u2019s start with a few indications for emergent pacing:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Symptomatic bradycardia<\/li><li>Complete heart block (3rd degree)<\/li><li>Second degree type II heart block<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">So, just remember&#8230;when your heart is racing because you need to do some emergent<br>pacing&#8230;your patient\u2019s heart rate is going to be LOW.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Types of Emergent Pacing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">There are three types of emergent pacing:<\/p>\n\n\n\n<ol class=\"wp-block-list\" type=\"1\"><li>Transcutaneous<\/li><li>Transvenous<\/li><li>Epicardial<\/li><\/ol>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"373\" height=\"252\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture2.jpg\" alt=\"\" class=\"wp-image-2532\" srcset=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture2.jpg 373w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture2-300x203.jpg 300w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture2-370x250.jpg 370w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture2-270x182.jpg 270w\" sizes=\"auto, (max-width: 373px) 100vw, 373px\" \/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">All of these methods are temporary measures until a patient gets a pacemaker, or the issue for pacing is resolved.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Single Chamber Pacing vs. Dual Chamber Pacing<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignleft size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"173\" height=\"377\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture3-2.png\" alt=\"\" class=\"wp-image-2533\" srcset=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture3-2.png 173w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture3-2-138x300.png 138w\" sizes=\"auto, (max-width: 173px) 100vw, 173px\" \/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Single chamber pacing vs. dual chamber pacing\u2026.What\u2019s the difference?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In single chamber pacing, only the atria or ventricle is being paced. This is usually done with transcutaneous pads OR a pacing lead in the right atrium or right ventricle.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In dual chamber pacing, both the atria AND ventricle are being paced. Dual chamber pacing requires two leads, and is typically done with epicardial wires.<\/p>\n\n\n\n<div style=\"height:37px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><a><\/a>Pacemaker Codes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">VVI, DDD, AAI\u2026.OH MY! Pacemaker codes can be so confusing&#8230;so let\u2019s break it down.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"461\" height=\"197\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture4-3.png\" alt=\"\" class=\"wp-image-2534\" srcset=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture4-3.png 461w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture4-3-300x128.png 300w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture4-3-370x158.png 370w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture4-3-270x115.png 270w\" sizes=\"auto, (max-width: 461px) 100vw, 461px\" \/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">-The first letter = chamber paced<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">-The second letter = chamber sensed<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">-The third letter = response to sensing<\/p>\n\n\n\n<div style=\"height:14px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Transcutaneous Pacing<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignleft size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture5.jpg\" alt=\"\" class=\"wp-image-2535\" width=\"399\" height=\"256\"\/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Transcutaneous pacing (TCP) is done via pads that are placed directly onto a patient\u2019s skin.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">These pads are the same as the ones you use during codes to \u201cshock\u201d patients and are typically found on your code cart, pacing cart, or in the supply room. It is important that you know where your transcutaneous pacing supplies are, though, because transcutaneous pacing usually happens very quickly when a situation warrants it.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">TCP is a non-invasive form of emergent pacing that is not as efficient as transvenous pacing. It requires more energy (most adults will need a minimum of 50mA) because it is done through electrodes placed onto the skin.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">TCP is a temporary method of pacing to stabilize a patient until a more permanent method can be accomplished. As you can imagine, this type of pacing is not very comfortable to patients who might be awake (as their CO improves so will their LOC)&#8230;so sedation or analgesia may be needed.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><a><\/a>Pad Placement Prep<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture6-1.png\" alt=\"\" class=\"wp-image-2536\" width=\"392\" height=\"204\"\/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Before you transcutaneously pace someone, it is important to make sure the the pads are properly placed and adhered to a patient\u2019s skin. Here are a few pad placement tips:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Make sure the skin is clean<\/li><li>Clip excess hair<\/li><li>Ensure pad is completely adhered to the skin<\/li><li>Anterior\/posterior placement preferred<\/li><li>Place pads 2 inches from permanent pacemaker<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><a><\/a>Demand vs. Asynchronous Modes<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignleft size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture7-1.jpg\" alt=\"\" class=\"wp-image-2537\" width=\"399\" height=\"269\" srcset=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture7-1.jpg 401w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture7-1-300x203.jpg 300w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture7-1-370x250.jpg 370w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture7-1-270x182.jpg 270w\" sizes=\"auto, (max-width: 399px) 100vw, 399px\" \/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">It is VERY important to know the difference between demand and asynchronous modes when it comes to pacing a patient. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In demand mode, pacing only happens when needed. The patient\u2019s intrinsic activity is detected and pacing is inhibited when activity is sensed. This mode is overall safer for patients.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In asynchronous modes, the pace rate is programmed and \u201cfixed\u201d regardless of a patient\u2019s intrinsic rhythm. This method can be unsafe when used inappropriately due to the \u201cR on T phenomena\u201d because it can lead to ventricular fibrillation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><a><\/a>Failure to Sense<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Failure to SENSE is a type of pacemaker failure when a pacemaker spike occurs where it shouldn\u2019t be. AKA\u2026the pacemaker has failed to sense the patient\u2019s underlying intrinsic rhythm. Some potential causes include: the positioning of the lead, battery failure, and improper settings.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture8.png\" alt=\"\" class=\"wp-image-2538\" width=\"357\" height=\"112\"\/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Here is what you can do:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Assess sensitivity threshold&#8211;the mV may be too high<\/li><li>Change the battery<\/li><li>Assess catheter position<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><a><\/a>Failure to Capture<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Failure to CAPTURE is a type of pacemaker failure where a pacing spike occurs but nothing follows. Some potential causes are: improper patient positioning, battery failure, low voltage, inadequate connection, and fibrosis of the catheter tip. <\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-full is-resized\"><img decoding=\"async\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture9.png\" alt=\"\" class=\"wp-image-2539\" width=\"400\" srcset=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture9.png 395w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture9-300x91.png 300w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture9-370x112.png 370w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture9-270x82.png 270w\" sizes=\"(max-width: 395px) 100vw, 395px\" \/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Here is what you can do:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Increase the mA 10% above capture threshold to give a safety margin<\/li><li>Reposition the patient<\/li><li>Change the battery<\/li><li>Reposition the catheter (need an MD for this)<\/li><li>Check labs<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><a><\/a>Failure to Pace<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Failure to PACE is a pacemaker failure where pacemaker spikes are \u201cmissing\u201d or do not occur at all. Some potential causes of this are: device issues (battery failure), lead dislodgement, or pad dislodgement. <\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture10-1.png\" alt=\"\" class=\"wp-image-2540\" width=\"412\" height=\"170\"\/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Here is what you can do:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Assess the connections\/pad adherence<\/li><li>Ensure device is plugged in<\/li><li>Get a new device<\/li><li>Start CPR if needed<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><a><\/a>Transvenous Pacing<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture11.jpg\" alt=\"\" class=\"wp-image-2541\" width=\"399\" height=\"269\"\/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Transvenous pacing is another type of emergent, temporary pacing you may come across. The pacing electrode is inserted through a vein and balloon-guided to the right ventricle. Transvenous pacers can be inserted at the bedside or in the cath lab. The right IJ is the preferred insertion site but the femoral vein or left subclavian may also be used. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Initial settings for transvenous pacing are typically:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Rate: 60-80ish bpm<\/li><li>Current (output): 5-10 mA is safe<\/li><li>Mode: VVI<\/li><li>Sensitivity: 2ish mV is safe<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">It is important to keep in mind that patients may need a higher energy (mA) in acidosis, electrolyte imbalances, or if the transvenous pacer has been in for a few days.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Proper Nursing Care for Transvenous Pacing<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"325\" height=\"308\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture12.png\" alt=\"\" class=\"wp-image-2542\" srcset=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture12.png 325w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture12-300x284.png 300w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture12-270x256.png 270w\" sizes=\"auto, (max-width: 325px) 100vw, 325px\" \/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">When caring for a patient with a transvenous pacemaker, it is important to keep the following in mind:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Immobilize affected extremity<\/li><li>Monitor extremity distal to insertion site<\/li><li>Possible bed rest<\/li><li>Daily chest x-ray<\/li><li>Do not bolus fluids through the introducer<\/li><li>Monitor for signs of perforation<\/li><\/ul>\n\n\n\n<div style=\"height:28px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Hiccups with Pacemaker<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignleft size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"328\" height=\"304\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture13.png\" alt=\"\" class=\"wp-image-2543\" srcset=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture13.png 328w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture13-300x278.png 300w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture13-270x250.png 270w\" sizes=\"auto, (max-width: 328px) 100vw, 328px\" \/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">If your patient ever has relentless hiccups with a cardiac pacing device, this needs to be taken seriously. Hiccups after cardiac pacemaker placement should raise concern for diaphragmatic pacing and lead perforation. This is a rare complication, but has the potential to be very lethal.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So&#8230;fun fact! If your patient keeps having hiccups&#8230;take them seriously and notify the provider!<\/p>\n\n\n\n<div style=\"height:29px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><a><\/a>Epicardial Pacing<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture14.png\" alt=\"\" class=\"wp-image-2544\" width=\"399\" height=\"269\"\/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Epicardial pacing is typically used in post-cardiac surgery patients, especially those who are coming off of bypass. These patients are at increased risk for arrhythmias, which are a major cause of mortality and morbidity after cardiac surgery. Temporary epicardial pacemakers have evolved from one-chamber systems to dual chamber, biatrial, and even biventricular systems!<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A few tidbits to keep in mind:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The (-) lead is used to pace, while the (+) lead is the \u201cground\u201d lead<\/li><li>Ventricular wires exit skin on the left<\/li><li>Atrial wires exit skin on the right<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><a><\/a>Stimulation (Energy) Threshold vs Sensing Threshold<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Let\u2019s chat about stimulation vs sensing thresholds. These two concepts are often very confusing for nurses, but they are SUPER important to comprehend when it comes to managing a temporary pacemaker.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignleft size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture15.jpg\" alt=\"\" class=\"wp-image-2545\" width=\"399\" height=\"269\" srcset=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture15.jpg 479w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture15-300x202.jpg 300w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture15-370x249.jpg 370w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2021\/11\/Picture15-270x182.jpg 270w\" sizes=\"auto, (max-width: 399px) 100vw, 399px\" \/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Stimulation = ENERGY<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The goal with the stimulation threshold is to use the least amount of energy as possible, but still capture pacing stimulus (mA\u2019s should be 2-3x higher than the threshold)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Sensing = VISION<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The goal in sensing is to prevent competitive pacing and pace when it\u2019s supposed to! (mV\u2019s should be \u00bd the threshold value)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is important to note that thresholds are only assessed if the patient has an underlying rhythm and is hemodynamically stable.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Indications for Emergent Pacing Over the next few weeks, we are going to be chatting all things related to emergent pacing!! When it comes to emergently pacing your patient, it can be a bit intimidating&#8230;but we want to break it down and make it EASY for you. Let\u2019s start with a few indications for emergent [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":2535,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[46],"tags":[],"ppma_author":[61],"class_list":["post-2530","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nurse-education"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\r\n<title>Pacing - The Blog - Nicole Kupchik Consulting and Education<\/title>\r\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\r\n<link rel=\"canonical\" href=\"https:\/\/www.nicolekupchikconsulting.com\/news\/pacing\/\" \/>\r\n<meta property=\"og:locale\" content=\"en_US\" \/>\r\n<meta property=\"og:type\" content=\"article\" \/>\r\n<meta property=\"og:title\" content=\"Pacing - The Blog - Nicole Kupchik Consulting and Education\" \/>\r\n<meta property=\"og:description\" content=\"Indications for Emergent Pacing Over the next few weeks, we are going to be chatting all things related to emergent pacing!! When it comes to emergently pacing your patient, it can be a bit intimidating&#8230;but we want to break it down and make it EASY for you. 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She especially enjoys teaching Cardiology &amp; Critical Care topics. She believes every Critical Care &amp; Progressive Care nurse should be certified in their specialty area. Seattle, WA is home for Nicole. She lives there with her adorable Bernedoodle Finley. In her spare time she enjoys hiking, biking, traveling, spending time with her friends and being an active volunteer with the Junior League of Seattle.","sameAs":["https:\/\/www.nicolekupchikconsulting.com"],"url":"https:\/\/www.nicolekupchikconsulting.com\/news\/author\/nicolekupchik\/"}]}},"authors":[{"term_id":61,"user_id":3,"is_guest":0,"slug":"nicolekupchik","display_name":"Nicole Kupchik","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/da9fe88a00544b10c1f2635e67fd37213471c1dc579e9877fca558e5b9edc11e?s=96&d=mm&r=g","author_category":"","first_name":"Nicole","last_name":"Kupchik","user_url":"https:\/\/www.nicolekupchikconsulting.com","job_title":"","description":"MN, RN, CCNS, CCRN, PCCN and Critical Care Clinical Nurse Specialist\r\n\r\nNicole Kupchik has been a Critical Care RN for over 25 years. She graduated in 1993 from Purdue University with an Associate Degree in Nursing. In 2002 she received a Baccalaureate degree from the University of Washington, Bothell. In 2008 she received a Master's Degree in Nursing specializing as a Clinical Nurse Specialist from the University of Washington Seattle.\r\n\r\nNicole started her career at St. Mary Medical Center in Hobart, IN. From there, she traveled the U.S., working in large academic facilities such as State University of New York (SUNY) and the University of California at Los Angeles (UCLA). She also worked in Albuquerque, NM, Phoenix, AZ, San Francisco, CA and Palm Springs, CA before finally landing in Seattle at the University of Washington, where she worked in the Cardiothoracic ICU for 5 years.\r\n\r\nIn 2001, she switched gears and accepted a position at Harborview Medical Center in the Neuro-Surgical ICU and Cardiac ICU. In 2002, she was part of a team that was one of the first hospitals in the US to implement Therapeutic Hypothermia after Cardiac Arrest. Nicole wrote protocols and published numerous papers on the success of the therapy. For this she was honored with the Washington State March of Dimes, Nurse of the Year Award in Research &amp; Innovation.\r\n\r\nIn 2007, she became a Critical Care Educator at Harborview Medical Center. The following year she accepted the role of Clinical Nurse Specialist for Cardiology, Critical Care and founded the Sepsis Program. Nicole made huge strides to implement programs and improve outcomes. Her innovative work with Harborview Medical Center's Sepsis Program was honored with 2 Washington State Qualis Awards for Patient Safety &amp; Clinical Leadership.\r\n\r\nNicole finds her passion as a popular lecturer and arms nurses with tools to create safe work and practice environments. Her casual style sets the tone for a relaxed, fun &amp; interactive learning environment. She especially enjoys teaching Cardiology &amp; Critical Care topics. She believes every Critical Care &amp; Progressive Care nurse should be certified in their specialty area.\r\n\r\nSeattle, WA is home for Nicole. She lives there with her adorable Bernedoodle Finley. In her spare time she enjoys hiking, biking, traveling, spending time with her friends and being an active volunteer with the Junior League of Seattle."}],"_links":{"self":[{"href":"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-json\/wp\/v2\/posts\/2530","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-json\/wp\/v2\/comments?post=2530"}],"version-history":[{"count":7,"href":"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-json\/wp\/v2\/posts\/2530\/revisions"}],"predecessor-version":[{"id":2552,"href":"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-json\/wp\/v2\/posts\/2530\/revisions\/2552"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-json\/wp\/v2\/media\/2535"}],"wp:attachment":[{"href":"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-json\/wp\/v2\/media?parent=2530"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-json\/wp\/v2\/categories?post=2530"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-json\/wp\/v2\/tags?post=2530"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-json\/wp\/v2\/ppma_author?post=2530"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}