Bradycardia (Complete)

Question 1

What is bradycardia?

Answer 1

HR <60 bpm

Question 2

What are causes of bradycardia?

Answer 2

Normal variant: Athletics

Heart block

MI

Drugs (e.g. Beta-blockers)

Electrolyte disturbances

Hypothyroidism

Sepsis

Raised intracranial pressure (Cushing’s reflex)

Question 3

Bradycardia can be assymptomatic unless there is evidence of haemodynamic comprimise. What are signs/symptoms of bradycardia in unstable patients?

Answer 3

Signs of shock

Syncope

Myocardial ischaemia

Heart failure

Question 4

What are signs of shock in haemodynamically unstable patients?

Answer 4

<90mmHg systolic

Pallor

Clammy extremities

Sweating

Confusion

Impaired consciousness

Question 5

What is the management plan for patients with bradycardia?

Answer 5

ABCDE approach

B: Maintain sats (Oxygen if needed)

C: ECG monitoring, BP, IV access

Identify and treat reversible causes

Pharmacological: IF EVIDENCE OF SHOCK or risk of asystole

IV atropine 500ug (micrograms/mcg)

IV atropine 500ug repeat up to 3mg if no response to initial treatment

OR

IV Isoprenaline 5ug or IV adrenaline 2-10ug

OR
Invasive:
Transcutaenous pacing (Only if initial IV atropine failed)

Expert help and transvenous pacing (If all measures above have failed)

Question 6

When would pharmacological/invasive treatment be offered to patients with bradycardia?

Answer 6

If there is evidence of haemodynamic instability

OR

If patient is at risk of asystole

Question 7

What are risk factors of asystole in patients with bradycardia?

Answer 7

Recent asystole

Mobitz II AV block

Complete heart block with broadened QRS

Ventricular pause > 3 seconds

Question 8

After initial A-E, what is the management plan for patients with bradycardia who are stable and have no risk factors of asystole?

Answer 8

Observe

Question 9

What management options should be considered if patient has not responsed to intial IV 500ug atropine?

Answer 9

Either of following:

Repeat IV 500ug atropine (Up to 3mg)

IV isoprenaline infusion

IV adrenaline infusion

Glucagon (If suspected beta-blocker or CCB overdose)

Transcutaneous pacing

Question 10

What is transcutaneous pacing?

Answer 10

Temporary means of pacing a patient’s heart during an emergency until a more permanent means of pacing is achieved

Question 11

How does Cushing’s reflex present?

Answer 11

Raised systolic BP

Low heart rate

Low resp rate

N.B. Basically opposite of shock