Adult Bradycardia

Question 1

When are we typically worried about bradycardia?

Answer 1

< 50 BPM with evidence of hypoperfusion

Question 2

initial management of bradycardia?

Answer 2

ABCDEs

1. Maintain airway
2. Oxygen if hypoxemic
3. Cardiac monitor to identify rythm, monitor BP and oximetry
4. IV access
5. 12-lead EKG
6. consider Hs and Ts

Question 3

If after addressing ABCDEs and the patient is still bradycardic, what do you do?

Answer 3

look for s/s of hypoperfusion

hypotension
AMS
Shock
Chest pain
Acute heart failure

Question 4

If the patient does NOT have s/s of hypoperfusion after doing ABCDEs, what do you do?

Answer 4

Monitor and observe

Question 5

If the patient DOES have s/s of hypoperfusion after doing ABCDEs, what do you do?

Answer 5

administer atropine

Question 6

What is the IV dose for atropine? How often do you repeat? Max dose?

Answer 6

1 mg bolus, repeat 3-5 minutes, max of 3 doses (3mg)

Question 7

If atropine (first line) does not work for brady, what are your options?

Answer 7

transcutaenous pacing
Dopamine infusion
Epinephrine infusion

Question 8

What is the infusion rate of dopamine for unresponsive bradycardia (failed atropine)?

Answer 8

5-20 mcg/kg/min tapering slowly

weight based

Question 9

What is the infusion rate of epinephrine for unresponsive bradycardia (failed atropine)?

Answer 9

2-10 mcg/min

notice it is NOT weight based

Question 10

what can Epi cause?

Answer 10

MI
toxicity
hypoxia
electrolyte abnormalities

Question 11

If atropine, trans pacing, dopa, and epi are not effective for adult brady, what do you do?

Answer 11

Expert consult + transVenous pacing