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.
- No identifiable P waves, QRS complexes, or T waves
- Irregular, chaotic baseline (coarse vs. fine VF)
- No measurable rate or rhythm
Recognition
- Chaotic, irregular waveform with no identifiable QRS
- No pulse, no perfusion
- Coarse vs. fine VF — both treated identically
Management
ACLS — shock first, shock often
- (push hard, push fast, minimize interruptions)
- 200 J biphasic ASAP, resume CPR for 2 min, then rhythm check
- 1 mg IV/IO q3–5 min after second shock
- 300 mg IV/IO after third shock; 150 mg for second dose. Lidocaine 1–1.5 mg/kg alternative
- 2 g IV only if torsades / hypomagnesemia
- — Hs and Ts
Refractory VF
- 500 mcg/kg bolus then 50 mcg/kg/min for sympathetic storm
Educational reference only. Always follow current ACLS guidelines and institutional protocols.