Peri-arrest rhythm: Bradycardia

Question 1

What is the management of bradycardia dependent on?

Answer 1

the presence of signs indicating haemodynamic compromise
The potential risk of asystole

Question 2

What are the potnetial adverse signs that would suggest haemodynamic compromise?

Answer 2

Shock
syncope
myocardial ischaemia
heart failure

Question 3

What are the main signs of shock to look for?

Answer 3

Hypotension (systolic blood pressure < 90 mmHg)
Pallor
Sweating
Cold
Clammy extremities
Confusion
Impaired consciousness

Question 4

What is the first line management of bradycardia peri-arrest?

Answer 4

Atropine (500mcg IV)

Question 5

If the patient didn’t react completely to the 500mcg of atropine, what can be administered next?

Answer 5

Atropine, up to a max 3mg

Question 6

What other interventions can be done for peri-arrest bradycardia?

Answer 6

Transcutaneous pacing
Isoprenaline/adrenaline infusion titrated to response

Question 7

What would indicate a potential risk of asystole?

Answer 7

complete heart block with broad complex QRS
recent asystole
Mobitz type II AV block
ventricular pause > 3 seconds

Question 8

A ventricular pause for how long would be a risk for asystole?

Answer 8

More than 3 seconds