Approach To Bradycardia

Question 1

List 5 signs of hemodynamic instability

Answer 1

1. Hypotension
2. Signs of shock
3. Altered mental status
4. Acute chest pain
5. Acute heart failure

Question 2

What is considered bradycardia in adults and children?

Answer 2

Adult: HR<50
Children: HR<60

Question 3

List 6 causes of bradycardia that start with H

Answer 3

1. Head injury
2. Hypothermia
3. Hyperkalemia
4. Heart block
5. Hypotension
6. Acidosis

Question 4

What toxin is notorious for causing bradycardia?

Answer 4

Organophosphate poisoning

Question 6

Name two commonest medications that cause bradycardia

Answer 6

Beta blockers and calcium channel blockers

Question 7

What is the immediate treatment of bradycardia in adults?

Answer 7

Atropine followed by adrenaline or transcutaneous pacing

Question 8

Which conditions should be excluded before atropine is given in the management of bradycardia?

Answer 8

Hypoxia, hypothermia and head injury

Question 9

What is the initial treatment of bradycardia caused by beta blockers overdose?

Answer 9

Glucagon

Question 10

What are the alternative options available for management of bradycardia in adults if adrenaline is not available?

Answer 10

Transvenous pacing or high dose insulin( 1 u if beta blocker overload) or glucagon for beta blockers overdose

Question 11

What is the next step after detecting unstable bradycardia in children?

Answer 11

Start CPR

Question 12

What is the medical management of bradycardia in children?

Answer 12

Adrenaline followed by atropineif vagal tone or first degree AV block and also consider pacing

Note in Adult it is Atropine followed by adrenaline