What is the first treatment step for unstable bradycardia?

• A. Administer epinephrine
• B. Defibrillate
• C. Initiate transcutaneous pacing (TCP)
• D. Observe without intervention

Answer: (C)

Unstable bradycardia demands rapid restoration of heart rate to improve organ perfusion. Transcutaneous pacing provides immediate external electrical stimulation to the ventricles, quickly increasing the ventricular rate and stabilizing blood pressure while you arrange definitive pacing or address the underlying cause. It’s a fast, noninvasive way to restore rhythm when a patient is symptomatic and unstable.

Defibrillation isn’t appropriate here because the patient has a slow rhythm with a pulse, not a shockable pulseless rhythm. Observing without intervention ignores the urgent need to improve perfusion. Epinephrine can support perfusion, but it doesn’t address the need for an immediate increase in heart rate as effectively or quickly as pacing in this scenario. So starting transcutaneous pacing first makes sense to stabilize the patient promptly.