Premature Ventricular Contractions

View Rhythm Strip
Transcutaneous PacingStep-by-step setup, capture & troubleshooting
TC Pacing — Quick Steps
Full guide →
  1. Apply pads anterior–posterior; attach ECG leads from the pacer/monitor.
  2. Pre-medicate for discomfort: midazolam ± fentanyl if BP allows.
  3. Set mode Demand (synchronous), rate 60–80/min.
  4. Increase output (mA) by 5–10 until electrical capture (wide QRS after each spike).
  5. Confirm mechanical capture: palpate femoral/right brachial pulse (not carotid).
  6. Set final output ~10 mA above threshold; reassess BP, perfusion, mentation.
  7. Bridge to transvenous pacing or treat underlying cause.
ANTERIORANTPOSTERIORPOSTSandwich the heart between pads
A–P pad placement

Rhythm strip

Source ↗
Normal sinus beatsWide, bizarre PVCNo preceding P waveCompensatory pause
Schematic placeholder — tap labels to highlight key features.

Tap a label on the strip to highlight the matching feature below.

  • Wide QRS (> 120 ms), bizarre morphology
  • No preceding P wave; early beat
  • Full compensatory pause after PVC
  • Otherwise normal sinus background
Recognition
  • Wide QRS (> 120 ms), bizarre morphology
  • No preceding P wave; full compensatory pause
  • Patterns: bigeminy, trigeminy, couplets, triplets (≥ 3 = NSVT)
Management
Workup
  • (K, Mg, Ca), TSH
  • (> 10–20%/day) or symptomatic
Treatment
  • (goal > 4) and Mg (goal > 2) in acute setting

Educational reference only. Always follow current ACLS guidelines and institutional protocols.