<s>
Transcutaneous	B-Algorithm
pacing	I-Algorithm
(	O
TCP	O
)	O
,	O
also	O
called	O
external	B-Device
pacing	I-Device
,	O
is	O
a	O
temporary	O
means	O
of	O
pacing	O
a	O
patient	O
's	O
heart	O
during	O
a	O
medical	O
emergency	O
.	O
</s>
<s>
It	O
should	O
not	O
be	O
confused	O
with	O
defibrillation	O
(	O
used	O
in	O
more	O
serious	O
cases	O
,	O
in	O
ventricular	O
fibrillation	O
and	O
other	O
shockable	O
rhythms	O
)	O
using	O
a	O
manual	O
or	O
automatic	O
defibrillator	O
,	O
though	O
some	O
newer	O
defibrillators	O
can	O
do	O
both	O
,	O
and	O
pads	O
and	O
an	O
electrical	O
stimulus	O
to	O
the	O
heart	O
are	O
used	O
in	O
transcutaneous	B-Algorithm
pacing	I-Algorithm
and	O
defibrillation	O
.	O
</s>
<s>
Transcutaneous	B-Algorithm
pacing	I-Algorithm
is	O
accomplished	O
by	O
delivering	O
pulses	O
of	O
electric	O
current	O
through	O
the	O
patient	O
's	O
chest	O
,	O
which	O
stimulates	O
the	O
heart	O
to	O
contract	O
.	O
</s>
<s>
The	O
most	O
common	O
indication	O
for	O
transcutaneous	B-Algorithm
pacing	I-Algorithm
is	O
an	O
abnormally	O
slow	B-Algorithm
heart	I-Algorithm
rate	I-Algorithm
.	O
</s>
<s>
By	O
convention	O
,	O
a	O
heart	O
rate	O
of	O
less	O
than	O
60	O
beats	O
per	O
minute	O
in	O
the	O
adult	O
patient	O
is	O
called	O
bradycardia	B-Algorithm
.	O
</s>
<s>
Not	O
all	O
instances	O
of	O
bradycardia	B-Algorithm
require	O
medical	O
treatment	O
.	O
</s>
<s>
It	O
is	O
only	O
when	O
bradycardia	B-Algorithm
presents	O
with	O
signs	O
and	O
symptoms	O
of	O
shock	O
that	O
it	O
requires	O
emergency	O
treatment	O
with	O
transcutaneous	B-Algorithm
pacing	I-Algorithm
.	O
</s>
<s>
Some	O
common	O
causes	O
of	O
hemodynamically	O
significant	O
bradycardia	B-Algorithm
include	O
myocardial	O
infarction	O
,	O
sinus	B-Algorithm
node	I-Algorithm
dysfunction	I-Algorithm
and	O
complete	B-Architecture
heart	I-Architecture
block	I-Architecture
.	O
</s>
<s>
Transcutaneous	B-Algorithm
pacing	I-Algorithm
is	O
no	O
longer	O
indicated	O
for	O
the	O
treatment	O
of	O
asystole	O
(	O
cardiac	O
arrest	O
associated	O
with	O
a	O
"	O
flat	O
line	O
"	O
on	O
the	O
ECG	B-Application
)	O
,	O
with	O
the	O
possible	O
exception	O
of	O
witnessed	O
asystole	O
(	O
as	O
in	O
the	O
case	O
of	O
bifascicular	B-Algorithm
block	I-Algorithm
that	O
progresses	O
to	O
complete	B-Architecture
heart	I-Architecture
block	I-Architecture
without	O
an	O
escape	B-Algorithm
rhythm	I-Algorithm
)	O
.	O
</s>
<s>
During	O
transcutaneous	B-Algorithm
pacing	I-Algorithm
,	O
pads	O
are	O
placed	O
on	O
the	O
patient	O
's	O
chest	O
,	O
either	O
in	O
the	O
anterior/lateral	O
position	O
or	O
the	O
anterior/posterior	O
position	O
.	O
</s>
<s>
The	O
pads	O
are	O
then	O
attached	O
to	O
a	O
monitor/defibrillator	O
,	O
a	O
heart	O
rate	O
is	O
selected	O
,	O
and	O
current	O
(	O
measured	O
in	O
milliamps	O
)	O
is	O
increased	O
until	O
electrical	O
capture	O
(	O
characterized	O
by	O
a	O
wide	O
QRS	B-Algorithm
complex	I-Algorithm
with	O
tall	O
,	O
broad	O
T	O
wave	O
on	O
the	O
ECG	B-Application
)	O
is	O
obtained	O
,	O
with	O
a	O
corresponding	O
pulse	O
.	O
</s>
<s>
Pacing	O
artifact	O
on	O
the	O
ECG	B-Application
and	O
severe	O
muscle	O
twitching	O
may	O
make	O
this	O
determination	O
difficult	O
.	O
</s>
<s>
Transcutaneous	B-Algorithm
pacing	I-Algorithm
may	O
be	O
uncomfortable	O
for	O
the	O
patient	O
.	O
</s>
<s>
Prolonged	O
transcutaneous	B-Algorithm
pacing	I-Algorithm
may	O
cause	O
burns	O
on	O
the	O
skin	O
.	O
</s>
<s>
Other	O
forms	O
of	O
cardiac	B-Device
pacing	I-Device
are	O
transvenous	B-Algorithm
pacing	I-Algorithm
,	O
epicardial	O
pacing	O
,	O
and	O
permanent	O
pacing	O
with	O
an	O
implantable	B-Device
pacemaker	I-Device
.	O
</s>
<s>
In	O
addition	O
to	O
synchronized	O
transcutaneous	B-Algorithm
pacing	I-Algorithm
offered	O
by	O
newer	O
cardiac	O
monitor/defibrillators	O
,	O
there	O
is	O
also	O
an	O
option	O
for	O
asynchronous	O
pacing	O
.	O
</s>
<s>
Sometimes	O
in	O
the	O
prehospital	O
setting	O
a	O
situation	O
may	O
arise	O
where	O
ECG	B-Application
electrodes	O
are	O
not	O
available	O
or	O
something	O
interferes	O
with	O
their	O
adhesion	O
to	O
the	O
patient	O
's	O
skin	O
.	O
</s>
