Resus - Bradycardy

Question 1

How is bradycardia defined in an adult?

Answer 1

• HR <60bpm

Question 2

What are the categorical causes of bradycardia? (4)

Answer 2

• physiological
• cardiac causes
• non-cardiac causes
• drugs

Question 3

What approach should be used to assess a patient with bradycardia?

Answer 3

• ABCDE

Question 4

What tends to be the initial treatments for patients with bradycardia, pharmacological or pacing?

Answer 4

•Pharmacological. Pacing is indicated in patients unresponsive to pharmacological treatment or with risk factors for asystole.

Question 5

What should be done when assessing a patient with bradycardia (using the ABCDE approach)? (5)

Answer 5

• Monitor spO2 and give oxygen if hypoxic
• Monitor ECG and record 12-lead ECG
• Monitor BP
• Obtain IV access
• Identify and treat reversible causes (e.g. electrolyte abnormalities)

Question 6

What are the adverse features when assessing a patient with bradycardia? (4)

Answer 6

• Shock
• Myocardial ischemia
• Syncope
• Heart failure

Question 7

If a patient has one of the 4 adverse features of bradycardia how should they be treated?

Answer 7

• Atropine 500 micrograms IV

Question 8

If a patient with bradycardia has adverse features and does not respond to atropine, what are three possible next steps? (3)

Answer 8

• Repeat atropine 500 micrograms every 3-5min up to 3mg
• Transcutaneous pacing
• Isoprenaline 5 micrograms/min IV or Adrenaline 2-10 micrograms/min IV (or alternative drugs)

Question 9

Be able to complete bradycardia algorithm. See iResus app.

Answer 9

Good job

Question 10

What are signs and symptoms of shock? (8)

Answer 10

• hypotension - SysBP <90 mmhg
• pallor
• sweating
• cold
• clammy extremities
• confusion or impaired consciousness

Question 11

Study tachycardia algorithm on iResus.

Answer 11

Do it…

Question 12

What are the adverse features of tachycardia? (4)

Answer 12

• Shock
• Heart failure
• Syncope
• Myocardial ischaemia

Question 13

If a patient has one of the adverse features of tachycardia, how should they be treated?

Answer 13

• Synchronised DC shock. Up to 3 times. (Conscious patients require sedation or general anaesthesia for cardioversion)
• Amiodarone 300 mg IV over 10-20 min
• Repeat shock
• Give amiodarone 900 mg IV over 24 h

Question 14

What is amiodarone?

Answer 14

• A class III antiarrhythmic drug
• Prolongs phase 3 of the cardiac action potential, thus increasing the refractory period
• Used to treat: VT / VF / wide complex tachycardia / AF / paroxysmal SVT
• Half life = 58 d

Question 15

What is adenosine?

Answer 15

• A class V antiarrhythimc drug
• Causes transient heart block in the AV node
• Used to treat a number of SVTs that do not improve with vagal manoeuvres
• Half life = <10 s