An unresponsive 67-year-old female is found on the floor with a blood pressure of 82/40 and a respiratory rate of 10. The carotid pulse matches the monitor rhythm. Which intervention is most appropriate?

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When a patient is unstable due to symptomatic bradycardia but still has a pulse, the priority is to raise the heart rate quickly to improve perfusion. Transcutaneous pacing delivers immediate external electrical stimulation to the heart, increasing the rate and helping restore adequate systolic pressure. In this scenario, the patient is unresponsive with hypotension and a slow respiratory rate, yet a carotid pulse is present and aligns with the monitor rhythm, indicating a perfusing rhythm rather than cardiac arrest. Pacing is the best immediate intervention to stabilize perfusion.

CPR would be inappropriate since there is a pulse. IV fluids alone may help if hypovolemia is a factor but won’t correct the underlying bradycardia. Defibrillation is not indicated because there is a pulse and the rhythm is not a shockable pulseless arrest.