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.
- QRS amplitude twists around baseline
- Polymorphic VT morphology
- Preceding long QT on baseline ECG
Recognition
- Polymorphic VT with QRS amplitude 'twisting' around baseline
- Preceding long QT on baseline ECG
- Often initiated by R-on-T PVC after a long-short cycle
Causes / triggers
- Drugs: methadone, ondansetron, haloperidol, azithromycin, fluoroquinolones, antiarrhythmics (Ia/III)
- Electrolyte: ↓ K, ↓ Mg, ↓ Ca
- Bradycardia, congenital long QT, hypothermia, ↑ ICP
Management
Acute
- 2 g IV over 1–2 min (repeat as needed) — first line even if Mg normal
- (UNsynchronized) if pulseless or sustained unstable
- 100–120 bpm, OR isoproterenol 2–10 mcg/min, to shorten QT and prevent recurrence
Educational reference only. Always follow current ACLS guidelines and institutional protocols.