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Transcutaneous Pacing Success!!! Part 2

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This is the second half of a two-part case presentation examining transcutaneous pacing. If you didn’t see yesterday’s post I highly suggest checking out Part 1 before continuing, but if you hate learning I suppose you can start here. Yesterday we examined a series of tracings that depicted transcutaneous pacing (TCP) in all its stages: […]

Transcutaneous Pacing Success!!! Part 1

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Anyone trained in transcutaneous pacing (TCP) needs to be able to identify the rhythm below instantly. It shows a patient being transcutaneously paced at 80 bpm and 125 mA on a LifePak 12 [the strip is labelled 130 mA but that refers to a point just past the end of the paper, I promise]. Well, […]

Revisiting Transcutaneous Cardiac Pacing

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“Transcutaneous cardiac pacing is an effective procedure for patients experiencing unstable bradycardia.” Or is it? If you’ve read Tom’s introduction to the subject of false capture you’re already ahead of the game. We’ve shown case after case of unstable bradycardia patients receiving ineffective transcutaneous pacing due to a lack of capture. In each case, phantom pacing impulses […]

A rare case of transcutaneous pacing (TCP) with true electrical and mechanical capture

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We all know by now that transcutaneous pacing (TCP) is no longer recommended for asystolic arrest. But what about patients who experience return of spontaneous circulation?

58 year old male CC: Unconscious – Conclusion

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Here is the conclusion to 58 year old male CC: Unconscious. This was an unusual case with an unfortunate outcome. Let’s look at the heart rhythm again.

58 year old male CC: Unconscious

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EMS is called to the residence of a 58 year old male patient who was found unconscious at the bottom of the stairs by the spouse. The patient responds to painful stimuli with a grimace. Respirations are shallow. Past medical history: MI, pacemaker/ICD, renal insufficiency Medications: Numerous – unable to locate at the time of […]

Using capnography to confirm capture with transcutaneous pacing (TCP)

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Those of you who have been following me for a while (here and other online forums) know that I have searching for cases where a patient was successfully paced with a Lifepak 12. I have reviewed dozens of cases where the treating paramedic thought the patient was being paced, but the rhythm strips showed only […]

Transcutaneous pacing (TCP) with a Lifepak 12

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Image credit: Physio-Control   I discovered an interesting quirk about the Lifepak 12 the other day. I’m sure many of you have been told (as I had been told) that the Lifepak 12 cannot perform TCP unless the limb lead electrodes are attached. There is a caveat to this (reference page 4-18 in the Operations […]

Transcutaneous Pacing (TCP): The Problem of False Capture

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Transcutaneous pacing (TCP) is perhaps the most underutilized and misunderstood intervention in all of ACLS. Why? Simple. Because it’s impossible to simulate during training. From the 2010 AHA ECC Guidelines – Part 8:3: Management of Symptomatic Bradycardia and Tachycardia “It is reasonable for healthcare providers to initiate TCP in unstable patients who do not respond […]