Which of the following is a contraindication for transcutaneous pacing?

Transcutaneous pacing involves applying electrical stimulation through the skin to manage bradycardia or certain types of asystole, particularly when there is an urgent need for pacing. One significant contraindication for this procedure is patient movement. This is because the successful delivery of pacing impulses relies on a stable and properly positioned connection between the pacing pads and the patient’s skin. If the patient is moving, it can complicate the electrical connection, potentially leading to ineffective pacing or discomfort for the patient.

In cases where the patient is moving significantly, it may result in ineffective pacing, as the electrical impulses might not properly reach the cardiac tissue, or may cause discomfort which could further increase patient movement, creating a cycle of ineffective treatment.

Other factors such as the presence of hypotension or a shockable rhythm do not contraindicate transcutaneous pacing but rather inform the broader clinical management of the patient until more definitive treatments can be initiated. Similarly, the diagnosis of myocardial infarction does not prevent the use of transcutaneous pacing; in fact, pacing may be indicated in certain situations associated with myocardial infarction. Thus, the primary concern in transcutaneous pacing is achieving a stable patient environment that allows for effective electrical stimulation.