ACLS: Bradycardia: Difference between revisions

No edit summary
 
(80 intermediate revisions by 13 users not shown)
Line 1: Line 1:
*Only intervene if pt is symptomatic
''This page is for bradycardia with a pulse; for bradycardia without a pulse (i.e. PEA) see [[Adult pulseless arrest]]''
**Hypotension, AMS, chest pain, pulm edema
 
*1st Line
==Background==
**Transcutaneous pacing
*HR < 60
**Chronotropes
*Intervention only necessary if patient is symptomatic (CASH gets the JOULES = chest pain, altered mental status, shortness of breath, hypotension)
***Dopamine 2-10mcg/kg/min
 
***Epineprhine 2-10mcg/min
==Categories==
*2nd Line
*'''Sinus node dysfunction'''
**Atropine 0.5mg q3-5m can be given as temporizing measure
**Sinus bradycardia
***Do not give if Mobitz type II or 3rd degree block is present
**Sinus arrest
*Transvenous pacing required if transQ pacing + chronotropes is ineffective
**[[Tachy-Brady Syndrome]] ([[Sick Sinus]])
**Chronotropic incompetence
*'''AV node dysfunction'''
**1st degree AV block
**2nd degree AV block Mobitz I/Wenckebach
**2nd degree AV block Mobitz II
**3rd degree AV block (complete heart block)
 
==Differential Diagnosis==
{{Symptomatic bradycardia}}
 
==Management==
[[File:ACLS-bradycardia.png|thumb|Algorithm for bradycardia with a pulse (Adapted from ACLS 2010)]]
*'''[[Atropine]]'''
**Can be used as temporizing measure (while awaiting pacing and/or chronotropes)
**Use cautiously in patients with ongoing ischemia (tachycardia may worsen ischemia)
**Avoid and/or do not rely on in wide complex bradycardia, especially in setting of ischemia<ref>Neumar RW et al. Part 8: Adult Advanced Cardiovascular Life Support. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.</ref>
**1mg q3-5min (max 3mg or 3 doses)
***May not work in 2nd/3rd degree heart block, heart transplant
***Priority is to use external cardiac pacemaking<ref>Burns, E. AV block: 3rd degree (complete heart block). http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/</ref>
***Block is below AV node so atropine will accelerate sinus rate, leading to worsening of block and increased fatigue of AV nodal cells
*'''Chronotropes'''
**[[Dopamine]] 5-20 mcg/kg/min, max 50 mcg/kg/min
**[[Dobutamine]] 2-20 mcg/kg/min, max 40 mcg/kg/min
**[[Epinephrine]] 2-10 mcg/min (~0.03-0.2 mcg/kg/min, max 1 mcg/kg/min)
**[[Isoproterenol]] 2-10 mcg/min
*'''[[Transcutaneous Pacing]]'''
*'''[[Transvenous Pacing]]'''
 
===[[Antidotes]] for toxicologic causes===
*[[Beta-Blocker Toxicity]]
**[[Glucagon]] 5mg IV Q10min (repeat up to 3 doses)
**[[Insulin]] 1U/kg bolus
**[[Intralipid]] (ILE)
*[[Calcium Channel Blocker Toxicity]]
**[[Calcium gluconate]] 3g
**[[Insulin]] 1U/kg bolus
**[[Intralipid]] (ILE)
*[[Digoxin Toxicity]]
**[[Dig immune Fab]] 10-20 vials
*[[Opioid Toxicity]]
**[[Naloxone]] 0.4mg IV
*[[Organophosphate Toxicity]]
**[[Atropine]] 2mg IV, double dose q5-30m until secretions controlled
**[[Pralidoxime]] 1-2g IV over 15-30min


==See Also==
==See Also==
*[[ACLS (Main)]]
*[[ACLS (Main)]]
*[[Bradycardia (Wide)]]
 
==External Links==
*[http://ddxof.com/simplified-acls-algorithms/ DDxOf: Simplified ACLS Algorithms]
*[https://emergencymedicinecases.com/treatment-bradycardia-bradydysrhythmias/ EM Cases Treatment of Bradycardia and Bradydysrhythmias]
 
==Video==
 
==References==
<references/>
 
[[Category:Cardiology]]
[[Category:Critical Care]]
[[Category:EMS]]

Latest revision as of 18:10, 23 April 2025

This page is for bradycardia with a pulse; for bradycardia without a pulse (i.e. PEA) see Adult pulseless arrest

Background

  • HR < 60
  • Intervention only necessary if patient is symptomatic (CASH gets the JOULES = chest pain, altered mental status, shortness of breath, hypotension)

Categories

  • Sinus node dysfunction
  • AV node dysfunction
    • 1st degree AV block
    • 2nd degree AV block Mobitz I/Wenckebach
    • 2nd degree AV block Mobitz II
    • 3rd degree AV block (complete heart block)

Differential Diagnosis

Symptomatic bradycardia

Management

Algorithm for bradycardia with a pulse (Adapted from ACLS 2010)
  • Atropine
    • Can be used as temporizing measure (while awaiting pacing and/or chronotropes)
    • Use cautiously in patients with ongoing ischemia (tachycardia may worsen ischemia)
    • Avoid and/or do not rely on in wide complex bradycardia, especially in setting of ischemia[1]
    • 1mg q3-5min (max 3mg or 3 doses)
      • May not work in 2nd/3rd degree heart block, heart transplant
      • Priority is to use external cardiac pacemaking[2]
      • Block is below AV node so atropine will accelerate sinus rate, leading to worsening of block and increased fatigue of AV nodal cells
  • Chronotropes
  • Transcutaneous Pacing
  • Transvenous Pacing

Antidotes for toxicologic causes

See Also

External Links

Video

References

  1. ↑ Neumar RW et al. Part 8: Adult Advanced Cardiovascular Life Support. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
  2. ↑ Burns, E. AV block: 3rd degree (complete heart block). http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/
Retrieved from "https://www.wikem.org/w/index.php?title=ACLS:_Bradycardia&oldid=376297"