The AHA now states that dopamine or epinephrine infusions are an equally effective alternative to TCP; however, these medications often take some time to get started.
When a patient has symptomatic bradycardia with signs of poor perfusion (change in mental status, poor blood pressure, decreased capillary refill, etc.), trans-cutaneous pacing is the treatment of choice.
Do not delay TCP for the patient with symptomatic bradycardia with signs of poor perfusion. The AHA recommends a 60/min beginning rate which can be modified up or down depending upon the patient’s clinical response. The dose for pacing ought to be set at 2mA (milliamps) higher than the dose that produces determined capture.
A carotid pulse shouldn't be used for assessment of circulation as TCP will produce muscular movements which will feel like a n arterial pulse in this region of the neck. Assess circulation using the femoral pulse. TCP is contraindicated for the hypothermic patient, and isn't a suggested treatment for asystole or PEA..
Contributing factors ought to be thought about throughout the ACLS protocol since reversal of a non-cardiac cause can probably return the patient to a state of adequate perfusion.