BRADYCARDIA, ADULT

Question 1

BRADYCARDIA, SYMPTOMATIC

Answer 1

• SINUS BRADYCARDIA
• JUNCTIONAL RHYTHM
• IDIOVENTRICULAR RHYTHM
• ATRIAL FIBRILLATION WITH SLOW VENTRICULAR RESPONSE
• MOBITZ I
• MOBITZ II
• COMPLETE HEART BLOCK,
• ALL WITH VENTRICULALAR RATE LESS THAN 60 BEATS PER MINUTE, WITH THE PATIENT HAVING A BP SYSTOLIC <90mm Hg AND ONE OR MORE OF THESE SYMPTOMS/SIGNS: CHEST PAIN, SHORTNESS OF BREATH, SKIN COOL, PALE OR DIAPHORETIC.

Question 2

02

Answer 2

10-15 LPM BY MASK

Question 3

APPLY

Answer 3

PACEMAKER PADS

Question 4

ESTABLISH

Answer 4

IV NORMAL SALINE

Question 5

TURN ON

Answer 5

EXTERNAL PACEMAKER. (IF THE PATIENT IS UNSTABLE AND IV ACCESS CANNOT BE ACHIEVED OR IS DELAYED, TURN ON EXTERNAL PACEMAKER AND ASSURE CAPTURE)

Question 6

IF SYSTOLIC BP IS <90 mm Hg and patient is still symptomatic

Answer 6

• GIVE 300 ml BOLUS NORMAL SALINE IV ( IF NO EVIDENCE OF CHF)
• GIVE ATROPINE 0.5mg IV (MAY REPEAT ATROPINE 0.5 mg EVERY 3-5 MINUTES TO TOTAL DOSE OF 3 mg.)

Question 7

If systolic BP is still <90 mm Hg and the patient is still symptomatic after the second dose of Atropine

Answer 7

begin Dopamine drip 5mcg/kg/min and increase gradually up to 20mcg/kg/min to maintain BP of 100-110 mm Hg systolic.

Question 8

NOTE:

Answer 8

Communicate with the base station physician as soon as possible for sedation if the patient is uncomfortable with the pacing.