ACLS: Bradycardia: Difference between revisions
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==Categories== | ==Categories== | ||
*'''Sinus node dysfunction''' | |||
**Sinus bradycardia | |||
**Sinus arrest | |||
**[[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== | ==Differential== | ||
*'''Ischemia/Infarction''' | |||
**Inferior MI (involving RCA) | |||
*'''Neurocardiogenic/reflex-mediated''' | |||
**Increased ICP | |||
**Vasovagal reflex | |||
**Hypersensitive carotid sinus syndrome | |||
**Intra-abdominal hemorrhage (i.e. ruptured ectopic) | |||
*'''Metabolic/endocrine/environmental''' | |||
**Hyperkalemia | |||
**Hypothermia (Osborn waves on ECG) | |||
**Hypothyrodism | |||
**Hypoglycemia (neonates) | |||
*'''Toxicologic''' | |||
**B-blocker | |||
**Ca-channel blocker | |||
**Digoxin toxicity | |||
**Opioids | |||
**Organophosphates | |||
*'''Infectious/Postinfectious''' | |||
**Chagas dz | |||
**Lyme dz | |||
**Syphilis | |||
*[[Sick Sinus Syndrome]] | |||
==Treatment== | ==Treatment== | ||
*'''Atropine''' | |||
**Can be used as temporizing measure (while awaiting pacing and/or chronotropes) | |||
**Use cautiously in pts w/ ongoing ischemia (tachycardia may worsen ischemia) | |||
**0.5mg q3-5min (max 3 mg or 6 doses) | |||
***may not work in 2nd/3rd deg HB, heart transplant | |||
*'''Chronotropes''' | |||
**Dopamine 2-10mcg/kg/min | |||
**[[Epinephrine]] 2-10mcg/min | |||
*'''[[Transcutaneous Pacing]]''' | |||
*'''[[Transvenous Pacing]]''' | |||
===Antidotes for toxicologic causes=== | ===Antidotes for toxicologic causes=== | ||
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==References== | ==References== | ||
*Semelka, M et al. Sick Sinus Syndrome: A Review. Am Fam Physician. 2013 May 15;87(10):691-696.http://www.aafp.org/afp/2013/0515/p691.html*afp20130515p691-t2. | |||
Revision as of 00:37, 7 June 2015
This page is for bradycardia with a pulse; for bradycardia without a pulse see Adult Pulseless Arrest (i.e. PEA)
Background
- Only intervene if pt is symptomatic (hypotension, AMS, chest pain, pulm edema)
Categories
- Sinus node dysfunction
- Sinus bradycardia
- Sinus arrest
- 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
- Ischemia/Infarction
- Inferior MI (involving RCA)
- Neurocardiogenic/reflex-mediated
- Increased ICP
- Vasovagal reflex
- Hypersensitive carotid sinus syndrome
- Intra-abdominal hemorrhage (i.e. ruptured ectopic)
- Metabolic/endocrine/environmental
- Hyperkalemia
- Hypothermia (Osborn waves on ECG)
- Hypothyrodism
- Hypoglycemia (neonates)
- Toxicologic
- B-blocker
- Ca-channel blocker
- Digoxin toxicity
- Opioids
- Organophosphates
- Infectious/Postinfectious
- Chagas dz
- Lyme dz
- Syphilis
- Sick Sinus Syndrome
Treatment
- Atropine
- Can be used as temporizing measure (while awaiting pacing and/or chronotropes)
- Use cautiously in pts w/ ongoing ischemia (tachycardia may worsen ischemia)
- 0.5mg q3-5min (max 3 mg or 6 doses)
- may not work in 2nd/3rd deg HB, heart transplant
- Chronotropes
- Dopamine 2-10mcg/kg/min
- Epinephrine 2-10mcg/min
- Transcutaneous Pacing
- Transvenous Pacing
Antidotes for toxicologic causes
- Beta-Blocker Toxicity
- glucagon 5mg IV Q10min (rpt up to 3 doses)
- Calcium Channel Blocker Toxicity
- Calcium gluconate 3g OR insulin 1U/kg bolus
- Digoxin Toxicity
- Dig immune Fab 10-20 vials
- Opioid Toxicity
- Nalaxone 0.4mg IV
- Organophosphate Toxicity
- Atropine 2mg IV OR Pralidoxime 2g IV over 10-15min
See Also
References
- Semelka, M et al. Sick Sinus Syndrome: A Review. Am Fam Physician. 2013 May 15;87(10):691-696.http://www.aafp.org/afp/2013/0515/p691.html*afp20130515p691-t2.