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.
- Short PR (< 120 ms)
- Delta wave — slurred QRS upstroke
- Wide QRS with secondary ST-T changes
Recognition
- Short PR interval (< 120 ms)
- Delta wave (slurred QRS upstroke)
- Wide QRS (> 110 ms)
- Secondary ST-T changes
Management
Pre-excited atrial fibrillation (FBI: Fast, Broad, Irregular)
- 20–50 mg/min IV (preferred)
- 1 mg IV over 10 min as alternative
- (or low threshold to use)
Orthodromic AVRT (narrow complex)
- — vagal, adenosine, then AV nodal blockade
- : EP study + accessory pathway ablation
Educational reference only. Always follow current ACLS guidelines and institutional protocols.