<P> During transcutaneous pacing, pads are placed on the patient's chest, either in the anterior / lateral position or the anterior / posterior position . The anterior / posterior position is preferred as it minimizes transthoracic electrical impedance by "sandwiching" the heart between the two pads . The pads are then attached to a monitor / defibrillator, a heart rate is selected, and current (measured in milliamps) is increased until electrical capture (characterized by a wide QRS complex with tall, broad T wave on the ECG) is obtained, with a corresponding pulse . Pacing artifact on the ECG and severe muscle twitching may make this determination difficult . It is therefore advisable to use another instrument (e.g. SpO2 monitor or bedside doppler) to confirm mechanical capture . </P> <P> Transcutaneous pacing may be uncomfortable for the patient . Sedation should therefore be considered . Before pacing the patient in a prehospital setting sedation is recommended by administering an analgesic or an anxiolytic . Prolonged transcutaneous pacing may cause burns on the skin . According to the Zoll M Series Operator's Guide," Continuous pacing of neonates can cause skin burns . If it is necessary to pace for more than 30 minutes, periodic inspection of the underlying skin is strongly advised ." It is meant to stabilize the patient until a more permanent means of pacing is achieved . </P> <P> Other forms of cardiac pacing are transvenous pacing, epicardial pacing, and permanent pacing with an implantable pacemaker . </P> <P> In addition to synchronized transcutaneous pacing offered by newer cardiac monitor / defibrillators there is also an option for Asynchronous Pacing . Sometimes in the prehospital setting a situation may arise where ECG electrodes are not available or something interferes with their adhesion to the patient's skin . In these rare situations where the patient must be paced and there are no other alternatives Asynchronous Pacing may be used . Again this setting should only be used as a last resort due to possible adverse cardiac effects it could cause . </P>

Can you touch a patient during transcutaneous pacing