Symptomatic Bradycardia

Question 1

Symptomatic Bradycardic Indications

Answer 1

Bradycardia AND Hemodynamic instability

Question 2

ATROPINE
Conditions
Age?
HR?
SBP?

Answer 2

Age: **≥ 18 years **
HR: < 50
SBP: Hypotension

Question 3

ATROPINE
Contraindications

Answer 3

1. Allergy or sensitivity
2. Hypothermia
3. History of heart transplant

Question 4

ATROPINE
Route - IV
Dose?
Max. Single Dose?
Dosing Interval?
Max. # of Doses?

Answer 4

Dose: 1mg
Max. Single Dose: 1mg
Dosing Interval: 5mins
Max. # of Doses: 2

Question 5

Transcutaneous Pacing
Conditions
Age?
HR?
SBP?

Answer 5

Age: ≥ 18 years
HR: < 50
SBP: Hypotension

Question 6

Transcutaneous Pacing
Contraindications

Answer 6

Hypothermia

Question 7

Transcutaneous Pacing
Treatment
Initial Rate?
Common mAmps for capture?
How do you confirm capture?
Once capture confirmed how much do you increase mAmps?
unable to gain capture at max mAmps?

Answer 7

Initial Rate: 80 BPM
Common mAmps for capture: 80 to 100
confirm capture: Palpate for pulse (feel mechanical capture)
increase mAmps after capture: 5-10% more
unable to capture: Discontinue pacing

Question 8

Transcutaneous Pacing
Treatment
Initial Rate?
Common mAmps for capture?
How do you confirm capture?
Once capture confirmed how much do you increase mAmps?
unable to gain capture at max mAmps?

Answer 8

Initial Rate: 80 BPM
Common mAmps for capture: 80 to 100
confirm capture: Palpate for pulse (feel mechanical capture)
increase mAmps after capture: 5-10% more
unable to capture: Discontinue pacing

Question 9

Do you require IV access prior to initiating TCP?

Answer 9

NO
TCP should not be delayed for placement of an IV if the patient is unstable

Question 10

Patients with presenting rhythm:
Sinus Bradycardia
Junctional Bradycardia
Atrial Fibrillation
1st Degree block
2nd Degree Type 1 Block
2nd Degree Type 2 Block
3rd Degree Block

all qualify for atropine if Heart Rate less than 50 BPM?

Answer 10

YES
atropine may not be as effective in 2nd degree Type 2 or 3rd degree but patients may receive a single dose while preparing for pacing or if pacing is unsuccessful / unavailable

Question 11

DOPAMINE
Conditions
Age?
HR?
SBP?

Answer 11

Age: ≥ 18 years
HR: < 50
SBP: Hypotension

Question 12

DOPAMINE
Contraindications

Symptomatic bradycardia

Answer 12

1. Allergy or Sensitivity
2. Mechanical Shock
3. Pheochromocytoma

Question 13

DOPAMINE
Route - IV
Initial infusion rate?
Titration increment?
Titration Interval?
Max. Infusion Rate?

SBP target?
Discontinuing?

Answer 13

Initial infusion rate: 5mcg/kg/min
Titration increment: 5mcg/kg/min
Titration Interval: 5mins
Max. Infusion Rate: 20mcg/kg/min

SBP target: ≥ 90 to < 110
Discontinuing: gradually 5 - 10mins

Question 14

if Dopamine goes interstitial it can cause necrosis, what medication can be given in hospital to mitigate?

Answer 14

Phentolamine
nonselective α-adrenergic antagonist

nice to know - not need to know