Transcutaneous Pacing (TCP)

ALS Defibrillator Functions
(Part 2 - TCP)

ALS Defibrillator = Advanced Life Support Defibrillator
Defibrillators used by medical providers. Typically by EMS and in advanced care settings Hospitals, Free standing ER's, etc.

A lot of medical providers are uncomfortable using the ALS Defibrillator in their medical care settings. This is largely due to the lack of training and the variety of brands and models on the market. This often leads to intimidation and delay in treatment.

Therefore, this series highlights the main features of the ALS Defibrillator. We want to get you thinking about and looking at your facilities defibrillator……NOW……and not during an emergency. Hopefully, this helps boost your confidence!

4 Part series will include:

Part 1: Using AED Mode for Defibrillation

Part 2: Using Pacing Mode for Transcutaneous Pacing (TCP)

Part 3: Synchronized Cardioversion

Part 4: Manual Mode for Defibrillation

Steps for Transcutaneous Pacing

General tips/steps for pacing:

Apply pads and 3 lead to patient. There is currently 1 set of pads on the market, made by ZOLL, that has a 3 lead built into the pad and does NOT require the additional 3 lead cable. They are called One Step Complete with One Step Pacing. View their informational handout.

Turn on Pacing function. See pictures below for where to locate the pacing features on some common defibrillators. 

Each defibrillator will have a default HR and mA preprogrammed (mA can be output or current depending on brand).

Adjust HR to desired PPM (pulse per minute).

Adjust mA until you have electrical and mechanical capture

What is electrical & mechanical capture?

Electrical Capture

Electrical capture is the EKG reading you see on the monitor. It is a widened QRS complex following every pacer spike.  

You will continue to increase the mA until you see full electrical capture. See picture below. No capture at 8 mA. Full capture at 68 mA. Also, watch the included video.

Mechanical capture

Determined by a palpable pulse

If the palpable pulse is lower than the set PPM on the defibrillator then you will continue to increase the mA until the palpable pulse matches

CAPTURE DOES NOT ALWAYS OCCUR. Be prepared for alternative treatments or the possibility of starting CPR. 

Video demonstrating steps & capture

Where to find Pacer Controls

Pictures of some of the most common ALS defibrillators: ZOLL, LIFEPAK, and PHILLIPS with guidance on where to locate the pacer functions. 

ZOLL

While several models of ZOLL Defibrillators are on the market they have similar visual features. 

Turning the dial to PACER will turn on defibrillator and activate the Pacer Function

LIFEPAK

While several models of LIFEPAK Defibrillators are on the market they have similar visual features. 

Turn on the defibrillator then Press the PACER button to activate the Pacer Function

PHILLIPS

These pictured Phillips Defibrillators were commonly seen in the hospital setting. They have been discontinued and no longer being supported by PHILLIPS. They are included in this blog as some hospitals still have them for use. 

My understanding, is the only ALS defibrillator that they will be making is the prehospital care Tempus ALS.

They will still be manufacturing AED’s for the community setting. 

Follow the steps seen on the pictures as they are quite different from one another.

THANK Y OU

Hope you enjoyed the post and found it helpful.
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