ACLS review: Bradycardia part 4

Transcutaneous pacing

·         TCP should not be delayed while waiting for an IV and Atropine

·         Set rate between 60-80/min

·         Begin at lowest mA and increase

·         Observe for electrical capture

·         Assess for mechanical capture

·         Consider analgesics and sedation for pain

Combo Pad Placement

·         Avoids pacemakers and ICDs

·         Insure the skin is dry

·         Shave excess hair if needed

·         Avoid medication patches

·         Avoid letting patches touch

·         Apex-anterior position

·         Anterior-posterior position

Combo Pad Placement

Transcutaneous Pacer Complex

Note: TCP stimulus does not work through the normal cardiac conduction system but by a direct electrical stimulus of the myocardium. Therefore, a “captured" complex will resemble a PVC. Electrical capture is characterized by a wide QRS complex, with the initial deflection and the terminal deflection always in opposite directions

Reviewed 2/28/16