Bradycardia

Question 1

What is the aim of our treatment for symptomatic bradycardia?

Answer 1

Restore adequate cardiac output for perfusion by increasing HR

Question 2

When is fluid resuscitation not indicated in symptomatic bradycardia?

Answer 2

In the presence of adequate preload

Question 3

In paediatrics, what is usually the cause of bradycardia?

Answer 3

Hypoxia and hypotension

Question 4

What are our 4 options for treating symptomatic bradycardia in an adult?

Answer 4

Combination therapy of:
Saline
Atropine
Adrenaline
Trans-cutaneous pacing (fixed mode)

Question 5

Protocol for Saline in Adults with Symptomatic Bradycardia?

Answer 5

IV/IO saline
-250mL aliquots up to 20mL/kg
-cease if signs of fluid overload

Question 6

Protocol for Atropine in Adults with Symptomatic Bradycardia?

Answer 6

IV/IO atropine
- 600mcg, repeat prn
- if ineffective after 1.2mg consider alternate treatment
- total max dose of 3mg

Question 7

With atropine, when should you consider an alternate treatment?

Answer 7

After two doses or 1.2mg

Question 8

What is the max dose of Atropine an individual can have?

Answer 8

3mg

Question 9

Protocol for Adrenaline in Adults with Symptomatic Bradycardia?

Answer 9

IV/IO adrenaline
Syringe driver = 5mcg/min
-consult if >50mcg/min required
OR
Manual infusion
-0.1mcg/kg/min =1 drop per sec = 6mcg/min
OR
Bolus
-25-50mcg

Question 10

Protocol for Trans-cutaneous Pacing in Adults with Symptomatic Bradycardia?

Answer 10

rate - balance cardiac worload and oxygen demand
electrical setting - minimum for ventricular capture and palpable pulse

Question 11

Once a patient is paced and there is adequate cardiac output what should we consider next?

Answer 11

Analgesia and anxiolysis
-Fentanyl
-Midazloam (1mg prn up to 5mg)

Question 12

Protocol for Saline in Paediatrics <16 with Symptomatic Bradycardia?

Answer 12

only if hypovolaemic
-Saline 10mL/kg aliquots (max 250mL) up to 20mL/kg

Question 13

Protocol for Atropine in Paediatrics <16 with Symptomatic Bradycardia?

Answer 13

Only if vagal stimulation or cholinergic toxicity is a factor
-20mcg/kg (max 600mcg)
-repeat once after 5 minutes

Question 14

Protocol for Adrenaline in Paediatrics <16 with Symptomatic Bradycardia?

Answer 14

Syringe driver
-Start at 0.5mcg/kg/min
-consult to discuss ongoing rates
-adjust by 0.1mcg/kg/min to a max of 2mcg/kg/min
OR
Manual infusion
-Start at 0.5mcg/kg/min = 1 drop per second = 6mcg/min

Question 15

Protocol for Trans-cutaneous in Paediatrics <16 with Symptomatic Bradycardia?

Answer 15

Only consider for refractory bradycardia