Transcutaneous PacingStep-by-step setup, capture & troubleshooting
TC Pacing — Quick Steps
Full guide →- Apply pads anterior–posterior; attach ECG leads from the pacer/monitor.
- Pre-medicate for discomfort: midazolam ± fentanyl if BP allows.
- Set mode Demand (synchronous), rate 60–80/min.
- Increase output (mA) by 5–10 until electrical capture (wide QRS after each spike).
- Confirm mechanical capture: palpate femoral/right brachial pulse (not carotid).
- Set final output ~10 mA above threshold; reassess BP, perfusion, mentation.
- Bridge to transvenous pacing or treat underlying cause.
Rhythm strip
Tap a label on the strip to highlight the matching feature below.
- Regular, narrow-complex tachycardia (150–220)
- QRS < 120 ms
- P waves absent, retrograde, or buried
Recognition
- Regular, narrow QRS (< 120 ms)
- Rate usually 150–220
- P waves absent, retrograde, or buried
- Most commonly AVNRT or AVRT
Management
Unstable
- 50–100 J (escalate as needed)
Stable
- — modified Valsalva (REVERT) is most effective
- 6 mg rapid IV push with flush; if no response → 12 mg → 12 mg
- : diltiazem, metoprolol, or amiodarone
Pearls / pitfalls
- Run a continuous 12-lead during adenosine — often unmasks underlying flutter or accessory pathway.
- Avoid adenosine if known WPW with pre-excited AF.
Educational reference only. Always follow current ACLS guidelines and institutional protocols.