Resus - Bradycardia (adult) 2015

Question 1

Step 1

Answer 1

ABCDE

• SpO2 and give oxygen
• 12-lead ECG
• BP
• IV access
• Treat reversible causes

Question 2

Step 2 (after ABCDE)

Answer 2

Adverse features

• Shock
• Syncope
• Myocardial ischaemia
• Heart failure

Question 3

Adverse features present

Answer 3

• Atropine 500mcg IV

Satisfactory response?

• Yes - go to no adverse features
• No - consider interim measures

Question 4

No adverse features

Answer 4

Risk of asystole?

• Recent asystole
• Mobitz II AV block
• Complete heart block with broad QRS
• Ventricular pause over 3s

If yes - consider interim measures
If no - continue observation

Question 5

Interim measures

Answer 5

Consider one of

• Repeat atropine 500mcg IV to maximum 3mg
• Transcutaneous pacing
• Isoprenaline 5mcg/min IV
• Adrenaline 2-10mcg/min IV
• Alternative drugs e.g. aminophylline, dopamine, glucagon (if cause is beta-blocker or calcium channel blocker), glycopyrolate (alternative to atropine)

Question 6

After interim measures

Answer 6

• Seek expert help

- Arrange transcutaneous pacing