Crash Cart 04: Transcutaneous Pacing (TCP)

Transcutaneous Pacing (TCP):
is a temporary means of pacing a patient’s heart during an emergency and stabilizing the patient until a more permanent means of pacing is achieved.
It is accomplished by delivering pulses of electric current through the patient’s chest, stimulating the heart to contract. The most common indication for TCP is symptomatic bradycardia, most commonly resulting from acute MI, sinus node dysfunction, and complete heart block. During TCP, pads are placed on the patient’s chest either in anterolateral position or anterior-posterior (AP) position.
The AP position is preferred because it minimizes transthoracic electrical impedance by sandwiching the heart between the two pads. Current is applied until electrical capture (characterized by a wide QRS complex since the SA node-AV node conducting pathway is bypassed, with tall, broad T-waves on the EKG) occurs. In addition to synchronized TCP, there is an option for asynchronous TCP in cases of VF, VT, complete heart block. Overdrive pacing is used to stop symptomatic tachydysrhythmias.
Finally, do not be fooled by the monitor into believing that the appearance of QRS complexes means that the patient’s heart has been captured and is delivering a sustainable blood pressure! You need to have some way to tell that the heart is being paced and generating a blood pressure; have a pulse oximeter or arterial line waveform for confirmation of the monitor’s electrical activity.
transcutaneous pacing steps
transcutaneous pacing indications
transcutaneous pacing pads

[@CYLiu13]

As a Internal and Emergency Medicine physician and always confused about TCP and too ashamed to ask for clarification and have searched numerous of explanation on TH-cam for the past 2-3 years, this is the best one and because of your video, I am very comfortable with TCP now.

[@criticalrnskills5326]

Thanks for sharing!

[@shaneb.3982]

Don't be ashamed. I'm a RN/EMT-P. I work in the ICU. We paced somebody for the first time in over a year. The Doctors and RN's had to come get me. I did a tutorial afterwards and am here to refresh myself. Funny thing is I had to go grab the same nurses to teach me how to do a bladder pressure. We all help each other.

[@mladenkapopovic1269]

Agree

[@bulletproofh2t]

great job, best video out there on TCP

[@cu99460]

Very nice. Very informative. Keep posting your work.

[@fpataca]

extremly usefull video, very clearly and simply explained! tnx colegue :)

[@thegamingguy3411]

Thank you. you have explained it in a simple way.

[@lz4181]

GREAT REVIEW! EASY AND CLEAR!

[@MissRateil]

Very useful. Thank you!

[@SolimanAnas]

Thanks for your clear explanation ❤.

[@AsifKhanhr93]

Really I appreciate your videos

[@danmagdziarz3727]

Awesome video - very practical - excellent resource for Emergency Medicine clinicians … colleagues, excel with the basics and build up for there!

[@hanoufessam9806]

I finally get it! Thank you so much.

[@islamtoot4187]

Well done! 👍 Useful info

[@epinamukhopadhyay6543]

Very useful and you made me understand it easily

[@SolimanAnas]

جزاك الله خير الجزاء ❤

[@Diana-up3rq]

Please keep posting videos! Explanation and demonstration 💯. Thank you

[@criticalrnskills5326]

Thank you, I will

[@asalkhodjaeva4064]

Very good! Thank you!

[@angeliquebeauty]

Thanks. Great video

[@swagmassa6702]

WOW. THANK YOU. I always understood how to Pace a pt on paper but when you do it in real life it is different.

[@zachsherman2121]

Awesome video

[@monaleezaalbert9002]

جزاك الله خير

[@athinabhuiyan1084]

Very well explained ..Thanks

[@guru801]

Nicely explained 👍

[@ludemergurango7013]

Informative video

[@KRAPYBARA84]

pretty cool

[@johannamanansala6828]

THANK YOU

[@buyisiledyantyi6553]

Wow bro. Nice one.

[@ahad3383]

الله يوفقك ويسعدك ويفرج همك فكيت ازمه

[@muayadmohammed2092]

شكراً يا اسطورة

[@dcommisso1123]

Fantastic Thanks

[@zliangbarnyanwaymongonlee7570]

thank you sir

[@chrisslight6457]

thanks a lot

[@b.1055]

شكرا

[@orenkrimchansky]

Thanks bro!

[@chocobiichocobii7237]

Super duper useful

[@eliasbshesh8639]

Thank u

[@user-xz2eh3sd8j]

Great !

[@muayadmohammed2092]

Brilliant!
Thank you so much

[@emuhlee.j6661]

This is good

[@phortunateejimone207]

Well presented. Came here after just admitting someone with SSS.

[@shobum1784]

❤

[@b.1055]

احببببببك

[@zingoringo4656]

شكرا عالشرح الواضح
السؤال ما هي درجة الألم للمريض الواعي؟! وهل ينفع اعمل هالتدخل بدون تخدير او مسكنات ألم

[@criticalrnskills5326]

يحتاج مسكنات وليس تخدير

[@coconutorange7609]

What you mean by goal?

[@criticalrnskills5326]

joule unit

[@decodingcap9965]

How to set the current? You said increase till capture, but capture is seen at lower currents, yet you kept on increasing. What is the end point?
Also if you are pacing for bradycardia, why set the pacing to trigger below 70bpm? Shouldn’t it be 50bpm as per ACLS algorithm?
Thank you!

[@criticalrnskills5326]

It didn't followed by QRS Until 80mA please see the video again
for ACLS symptomatic bradycardia 50 is to consider brady but not for pacing

[@decodingcap9965]

@@criticalrnskills5326 Thank you!