RRAPID: Bradycardia

Question 1

Definition?

Answer 1

ECG rate < 50 beats/min

Question 2

Causes?

Answer 2

SA block (ischaemia, hyperkalaemia, excessive vagal tone)
First degree heart block 
Type I Second degree heart block
Type II Second degree heart block
Third degree (Complete) heart block

Question 3

ECG changes is first, second (II & II) and third degree heart block?

Answer 3

1o HB: PR interval >200ms (5 small squares)

2o Type I: repeated lengthening of PR until a P not followed by QRS complex.

2o Type II: constant PR with intermittent QRS absence

3o HB: both P waves & QRS complexes present but independent.

Question 4

Response (Airway)?

Answer 4

Give O2 15L/min via a reservoir bag

Question 5

Response (Breathing)?

Answer 5

Monitor O2 sats

Question 6

Response (Circulation)?

Answer 6

IV access (fluids PRN)
Bloods: FBC, U&E’s, LFT’s, calcium, magnesium, glucose
12 lead ECG
Identify cause and adverse features

Question 7

Adverse features?

Answer 7

Shock
Syncope
MI
HF

Question 8

Mx of Bradycardia with adverse features?

Answer 8

Atropine 500 mcg IV
Repeat this dose every 3-5 mins up to a max of 3mg
Consider transcutaneous pacing

Question 9

First thing to assess before Mx of bradycardia without adverse features?

Answer 9

Asses risk of asystole

Question 10

Risks of asystole? (4)

Answer 10

Recent asystole
Mobitz II HB
Complete HB (3o) with broad QRS
Ventricular pause > 3s

Question 11

Mx of bradycardia without adverse features WITH risk of asystole?

Answer 11

Atropine 500 mcg IV
Repeat this dose every 3-5 mins up to a max of 3mg
Consider transcutaneous pacing (SEEK HELP)

Question 12

Mx of bradycardia without adverse features WITHOUT risk of asystole?

Answer 12

Observe