Case 7 - Bradycardia

Question 1

What is meant by “functional” or “relative” bradycardia?

Answer 1

This is a heart rate that is with a normal sinus rate, but due to a process like sepsis or cardiogenic shock, they do not have adequate perfusion.

Question 2

For the purposes of ACLS, a heart rate less than ____ is considered bradycardia.

A. 40 BPM
B. 50 BPM
C. 60 BPM
D. 70 BPM

Answer 2

C. 60 BPM

Question 3

What is the difference between a “sign” and a “symptom?”

Answer 3

Signs - described by the patient (ex: “dizziness”)

Symptom - observed by the provider (ex: “hypotension”)

Question 4

What is the critical “decision” point in management of adult bradycardia?

A. Adequate vs. inadequate perfusion
B. STE on 12-lead ECG
C. HR < 70 BPM

Answer 4

A. adequate vs inadequate perfusion

Question 5

What is the first dose of atropine for symptomatic adult bradycardia?

A. 0.5 mg IV/IO
B. 1 mg IV/IO
C. 1.5 mg IV/IO

Answer 5

A. 0.5 mg IV/IO`

Question 6

Atropine for symptomatic adult bradycardia may be repeated until what maximum dose is reached?

Answer 6

3 mg IV atropine

Question 7

What are the second line options for symptomatic adult bradycardia?

Answer 7

• TCP

- 2-20 mcg/kg/min dopamine

Question 8

Why is it important to quickly treat symptomatic bradycardia?

Answer 8

Symptomatic bradycardia is considered a pre-arrest rhythm.

Question 9

In what heart blocks is atropine withheld?

Why?

Answer 9

• Second degree, type II (multiple dropped QRS complexes)
• Third degree AV block

These blocks occur along infranodal (specifically below the AV node) pathways. As a result, they are not responsive to the anticholinergic effects of atropine.

Question 10

What are the absolute contraindications for atropine in heart block?

Answer 10

• Second degree, type II AV block

- Third degree AV block

Question 11

When should you move to TCP if atropine fails?

Answer 11

After 2-3 doses of atropine OR if the patient is experiencing severe symptoms.

Question 12

What is a relative contraindication for atropine in bradycardia?

Answer 12

• In the presence of ACS/MI. Atropine may worsen ischemia.

Question 13

What is absolutely imperative to be performed while pacing?

Answer 13

Ensure electromechanical capture!!! (CHECK…A…PULSE!)

Question 14

In what situation might epinephrine and dopamine be useful in bradycardia?

Answer 14

In the presence of a beta-blocker overdose. Epi/Dopamine are beta-agonists, and may overcome the competitive inhibition associated with these drugs.

Question 15

Which pulse is NOT used in assessment of electromechanical capture?

Answer 15

Carotid. TCP may cause contraction of neck musculature that mimics a carotid pulse.

Question 16

In some patients with severe symptomatic bradycardia, ventricular escape rhythms may precipitation ____.

Answer 16

VF/VT.

Question 17

TCP electrodes should be paced in what patients with what conditions?

Answer 17

• MI
• symptomatic sinus node dysfunction
• asymptomatic second degree, type II
• asymptomatic 3rd degree
• newly acquired bundle branch blocks in setting of MI