INTRODUCTION:

TCP has become in recent years the preferred therapy for rhythms previously treated with drug therapy. Refer to the Dysrhythmias - General protocol for indications of this procedure.

1. Initial Preparation/Settings
   1. Liberally record ECG during procedure.
   2. Initial rate: 60-80 (Adjust based on patient cardiac response & blood pressure).
   3. Initial current: 50 milliamps.
   4. In pulseless or severly hypotensive bradycardia unresponsive to Atropine or with asystole: Be prepared to use maximum milliamps and decrease if capture occurs.
   5. Patient may require medication for pain control (Morphine) or amnesic effect (Diazepam). If you are able to obtain pacer capture, you may administer:
      1. Morphine Sulfate 2 mg. IVP q 3-5 minutes titrated to effect.
      2. Diazepam 2-10 mg slow IVP. (Titrate to effect)

1. For proper electrical capture, you should be able to identify:
   1. Artificial pacer spike
   2. QRS complex
   3. T-wave of opposite polarity from the QRS. (This is Essential!)

2. Once electrical capture has occurred, verify mechanical capture by presence of a palpable pulse. Remember that many patients will have involuntary muscle contractions as a result of the TCP. This commonly causes muscle 'twitches' to be misinterpreted as pulsations. It is a good idea to verify pulses at multiple pulse-points.