Bradycardia Flashcards
Clinical features of bradycardia:
HR less than 60
Possible hypotension
Dizziness, mental status changes, nausea/vomiting
DDX of bradycardia (CNS)
increased ICP
vagal stimulation
spinal shock
DDX of bradycardia: CV
MI
sick sinus syndrome
AV blocks
What is sick sinus syndrome?
SA node degeneration leading to bradycardia and often complicated by intermittent SVT
DDX of bradycardia: pulmonary
Hypoxemia
DDX of bradycardia-metabolic:
acidosis, hypothermia
DDX of bradycardia-endocrine
hypothyroidism, adrenal insufficiency
DDX of bradycardia: drugs
beta blockers anesthetic drugs K+ (otassium levels above 6,0 mmol/l cause peaked T waves, wider QRS komplexes and may result in bradycardia, asystole and sudden death.) Ca++ (hypocalcemia) digoxin
How do you manage bradycardia?
Verify Brady (HR tracing on SpO2, EKG, manual pulse) Maintain patent airway confirm rhythm on EKG Surgical causes (traction on bowel)
If bradycardia starts changing mental status, causing chest pain, or hypotension, then what?
Atropine 0.5 mg IV
epinephrine 10 micrograms to 20 microgram bolus
infusion of epic (2-10 mcg/min)
If refractory to pharmacologic measures, prepare for transcutaneous pacing
If bradycardia has mild symptoms (mild-moderate hypotension, nausea/vomiting), then what?
Give atropine 0.4 mg IV
ephedrine 5-10 mg IV
glycopyrrolate 0.2 mg