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.
- Rate typically 100–250 bpm, usually regular
- Wide QRS (>120 ms), uniform or polymorphic
- AV dissociation, fusion or capture beats favor VT
- Monomorphic morphology — uniform QRS shape
Recognition
- Wide QRS (> 120 ms), rate usually 120–250
- Monomorphic (uniform) or polymorphic (varying)
- AV dissociation, capture/fusion beats favor VT
- Wide-complex tachycardia with structural heart disease = VT until proven otherwise
Management
Pulseless VT
- — defibrillate 200 J biphasic, CPR, epi 1 mg q3–5 min
- 300 mg IV push (then 150 mg) or lidocaine 1–1.5 mg/kg
Unstable VT with pulse
- 100 J biphasic, escalate as needed
Stable monomorphic VT with pulse
- 20–50 mg/min (max 17 mg/kg) — preferred
- 150 mg IV over 10 min, repeat as needed
- 1–1.5 mg/kg IV — alternative, esp. ischemic VT
- (> 4) and Mg (> 2)
Pearls / pitfalls
- Stable VT can become unstable VT in seconds — pads on, sedation drawn up.
- Polymorphic VT with normal QT → ischemia until proven otherwise.
Educational reference only. Always follow current ACLS guidelines and institutional protocols.