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Transcutaneous Pacing (TCP)
Transcutaneous Pacing (TCP)
Preparation
Preparation
Switch on the defibrillator.
Connect ECG leads from the defibrillator to the patient.
Remove defib pads with a twisting motion.
Attach pacing pads to the patient.
Initiating Pacing
Initiating Pacing
Press the “Pacer” button.
Open Options → Pacing, and ensure Demand Mode is selected.
Set Rate: Usually 70 bpm.
Set Current:
Start at 10 mA.
Gradually increase until you see electrical capture (each pacing spike followed by a QRS complex).
Assessing Capture
Assessing Capture
Monitor the patient: Ask about pain or discomfort.
If present, sedate and give analgesia.
Confirm mechanical capture:
Check the radial pulse.
Ensure the palpated pulse rate matches the paced heart rate on the monitor.
Once capture is achieved, increase current by 20 mA above the capture threshold.
Before Starting Pacing
Before Starting Pacing
Attempt atropine 1 mg IV every 5 minutes, up to 3 doses, before initiating pacing
If Pacing Is Not Possible or Uncomfortable
If Pacing Is Not Possible or Uncomfortable
Start dopamine infusion: 5–20 mcg/kg/min
ORStart epinephrine infusion: 2–10 mcg/min
Addressing Possible Underlying Causes
Hyperkalemia (Suspect in renal failure, ECG changes)
Give calcium gluconate 2 g IV.
Patients may improve dramatically after calcium administration.
Hypokalemia (Suspect in AGE with ECG changes)
Give 20 mEq KCl IV, divided as:
10 mEq in each IV line (if two cannulas available).
Infuse over 20 minutes.
Rapid infusion (over 2 minutes) is only for cardiac arrest or if a central line is available.
Unsure of Potassium Status
If hyperkalemia is possible and hypokalemia unlikely, giving calcium gluconate is safe.
Toxicologic Causes
Possible culprits: digoxin, beta-blockers, calcium-channel blockers, amiodarone, clonidine, organophosphates.
Contact a senior immediately and follow toxicology guidance.
Additional Workup
Additional Workup
If a blood gas analysis is available, check potassium (K⁺) and treat accordingly.
Author: Faysal Subhani
Editor: Ayesha Saeed
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