ACLS - Bradycardia

Question 1

Symptomatic Bradycardia

Answer 1

When bradycardia is the cause of signs/symptoms, the heart rate is generally
less than 50 bpm

Question 2

A symptomatic bradycardia exists clinically we see this triad:

Answer 2

○ Slow heart rate is present
○ The patient has symptoms
○ The symptoms are due to the slow heart rate

Question 3

Third degree AV block (complete block) is the most important and clinically
significant because it is the block that is most likely to cause ______

Answer 3

cardiovascular collapse and require immediate pacing.

Question 4

Higher AV node block, usually
transient and benign, rarely
progresses to 3rd degree block

Answer 4

Type 1 (Wenckebach)

Question 5

Lower block (His bundle), far
more serious and capable of
progressing to sudden 3rd
degree heart block

Answer 5

Type 2

Question 6

AV dissociation, where the atria and
ventricles are driven by independent
pacemakers.

Answer 6

Third Degree AV Block (Complete)-

Question 7

For assessment in Bradycardia we use ABCD:

Answer 7

○ Airway
○ Breathing
○ Circulation
● Differential
○ Evaluate the rhythm on a cardiac monitor and identify AV blocks.
○ Interpret the 12-lead EKG, looking closely for ischemia

Question 8

Several bradycardic rhythms are due to _____

Answer 8

acute ischemia of conduction tissue and pacing centers

Question 9

If your patient is persisting in a bradyarrhythmia, a vital decision in the
management is determining whether or not _____

Answer 9

there are signs and symptoms
relating to the bradycardia

Question 10

The treatment sequence for bradycardia is as follows:

Answer 10

Give Atropine as first-line treatment
0.5 mg IV (may repeat to a total of 3 mg)
Transcutaneous Pacing
OR
Dopamine Infusion
or
Epinephrine Infusion

Question 11

In the absence of immediately reversible causes, Atropine is the first-line
drug for acute _____

Answer 11

symptomatic bradycardia

Question 12

Atropine MOA

Answer 12

Reverses cholinergic-mediated decreases in heart rate and AV node conduction.

Question 13

Should be used cautiously in ischemia or MI, as an ______-mediated increase in HR can worsen ischemia

Answer 13

atropine

Question 14

atropine Adverse reactions

Answer 14

anaphylaxis, acute angle-closure
glaucoma, sudden tachycardia, and severe paradoxical bradycardia

Question 15

Avoid relying on Atropine in _____

Answer 15

Type 2 second degree or third degree AV block.
○ These two bradyarrhythmias are not likely to respond to reversal of
cholinergic effects with Atropine.
○ Instead, they are preferably treated with TCP or Beta-Adrenergic
support as a temporary measure while the patient is prepared for
transvenous pacing

Question 16

Transcutaneous Pacing (TCP)

Answer 16

● TCP is a useful ACLS treatment for symptomatic bradycardia and is
considered non-invasive.
● Most defibrillators have a “Pacing” mode for this purpose.
● This stimulates cardiac contraction and becomes an external, temporary,
transcutaneous pacemaker for the heart.

Question 17

We should consider immediate ____ in unstable patients with high-degree
heart blocks with no IV access or those who don’t respond to Atropine

Answer 17

TCP - Transcutaneous Pacing

Question 18

TCP is contraindicated in _____

Answer 18

severe hypothermia and is not recommended for patients
in asystole (TCP is not part of cardiac arrest)

Question 19

TCP should be considered an
emergent bridge to
______

Answer 19

transvenous pacing

Question 20

Beta-Adrenergic Infusion

Answer 20

● Dopamine and Epinephrine are beta-adrenergic agonists that have heart
rate-accelerating effects and are second-line options in our algorithm.
● These are alternatives to TCP, or in special circumstances
such as overdose with beta-blocker or CCB.

Question 21

If the patient did not respond well to Atropine and/or beta-adrenergic
agonist infusion, and TCP was required, preparations should be made
for ______

Answer 21

transvenous pacing