Summary Cardiac Emergencies OSCE Bundle: Transcutaneous Pacing & DC Cardioversion

Cardiac Emergency Procedures: Transcutaneous
Pacing (TCP) & DC Cardioversion (DCCV)

🟦 Overview
🔹 Transcutaneous Pacing (TCP)
 Temporary non-invasive pacing method.
 Delivers electrical impulses via external chest pads.
 Used for bradyarrhythmia’s with life-threatening features.
 Bridge to transvenous pacing.
🔹 Direct Current Cardioversion (DCCV)
 Delivers a synchronised shock with R-wave of QRS.
 Used to restore sinus rhythm in certain tachyarrhythmias.


🟩 Indications
TCP
 Bradycardia with any life-threatening feature:
o Shock
o Syncope
o Myocardial ischaemia
o Heart failure
 High-risk of asystole:
o Recent asystole
o Mobitz II block
o Complete heart block + broad QRS
o Ventricular pause > 3 sec
DCCV
 Unstable tachyarrhythmias (same 4 life-threatening features).
 Stable tachyarrhythmias unresponsive to:
o Vagal manoeuvres
o Adenosine
o Flecainide
 Atrial fibrillation/flutter (elective)


🟨 Contraindications
TCP
 Absolute: Patient refusal
DCCV
 Patient refusal
 Uncorrected severe electrolyte disturbances
 AF >48 hrs without ≥3 weeks anticoagulation
 Left atrial thrombus