Post-ROSC Care and Pacing: Prove the Perfusion

Getting a pulse back feels like a win. Seeing pacer spikes and something that resembles a pulse feels reassuring. But in both situations, the monitor can make you feel better before the patient actually is. Geoff Murphy of Master Your Medics breaks down the fragile minutes after return of spontaneous circulation. He explains why hypotension deserves immediate attention, how falling end-tidal CO2 can warn that cardiac output is deteriorating, and when fluids can serve as a short bridge to vasopressors. Then, paramedic Jacob Miller challenges some of the assumptions clinicians learn about transcutaneous pacing. He discusses pad placement, pacing current, ultrasound, pharmacologic support, and why clinicians need to keep reassessing even after they think they have capture. In this episode, you’ll learn: Why an initially normal blood pressure after ROSC can be falsely reassuring How skeletal muscle contraction during pacing can create ECG artifact and a false sense of mechanical capture What can improve your chances of capturing a patient when transcutaneous pacing is needed Why practicing the pacer during routine monitor checks can make a rare, high-stress call much easier to manage Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Interested in ABLS Now? Our listeners get 10% off with code LOUD26POD. Jacob’s Resources: Article with images of false vs true electrical capture: Kimbrell J, Kreinbrook J, Poke D, et al. False Electrical Capture in Prehospital Transcutaneous Pacing by Paramedics: A Case Series. Prehosp Emerg Care. 2024;28(7):928-936. doi: 10.1080/10903127.2024.2321287   Link to Scott Weingart's EMCrit podcast episode discussing false positive SpO2 signal without actual capture:  https://emcrit.org/emcrit/tcp-pulse-ox-fail/   Jacobs website with handout version of my slides:  https://jacobmilleracnp.com/slides/   Guests: Geoff Murphy, Founder and Lead Educator of Master Your Medics Jacob Miller, paramedic, flight nurse, critical care nurse, nurse practitioner, and DNP