رجل عمره ٧٩ سنة جاء بنبض ٣٦ مع إحصار كامل، وضغطه ٧٦/٤٠، ومشوش، ولم يستجب للأتروبين. ركب الممرض أقطاب التنظيم عبر الجلد، والشاشة تظهر شوكات المنظم بسرعة ٧٠. كيف يتأكد أن التنظيم فعّال؟

A 79-year-old man presents with HR 36 in complete heart block, BP 76/40 and confusion, unresponsive to atropine. The nurse applies transcutaneous pacing pads and the monitor shows pacing spikes at 70. How does the nurse confirm effective pacing?

1. Chest-muscle twitching with each pacing spike
2. A QRS after each spike and a matching femoral pulse
3. Improved skin colour without needing a pulse check
4. Pacing spikes appearing on the monitor only

Answer: B) A QRS after each spike and a matching femoral pulse. Electrical capture shows as a wide QRS after each spike, and mechanical capture is confirmed by a femoral pulse matching the paced rate. Muscle twitching can mimic a pulse, so the femoral pulse is preferred.