ACLS: Bradycardia: Difference between revisions
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==Treatment== | ==Treatment== | ||
#'''[[Atropine]]''' | |||
#*Can be used as temporizing measure (while awaiting pacing and/or chronotropes) | |||
#*Use cautiously in patients with ongoing ischemia (tachycardia may worsen ischemia) | |||
#*0.5mg q3-5min (max 3mg or 6 doses) | |||
#**may not work in 2nd/3rd degree heart block, heart transplant | |||
#'''Chronotropes''' | |||
* | #*[[Dopamine]] 2-10mcg/kg/min | ||
#*[[Epinephrine]] 2-10mcg/min | |||
#'''[[Transcutaneous Pacing]]''' | |||
#'''[[Transvenous Pacing]]''' | |||
===Antidotes for toxicologic causes=== | ===Antidotes for toxicologic causes=== | ||
| Line 57: | Line 57: | ||
**glucagon 5mg IV Q10min (rpt up to 3 doses) | **glucagon 5mg IV Q10min (rpt up to 3 doses) | ||
*[[Calcium Channel Blocker Toxicity]] | *[[Calcium Channel Blocker Toxicity]] | ||
**Calcium gluconate 3g OR insulin 1U/kg bolus | **[[Calcium gluconate]] 3g OR insulin 1U/kg bolus | ||
*[[Digoxin Toxicity]] | *[[Digoxin Toxicity]] | ||
**Dig immune Fab 10-20 vials | **[[Dig immune Fab]] 10-20 vials | ||
*[[Opioid Toxicity]] | *[[Opioid Toxicity]] | ||
**Nalaxone 0.4mg IV | **[[Nalaxone]] 0.4mg IV | ||
*[[Organophosphate Toxicity]] | *[[Organophosphate Toxicity]] | ||
** | **[[Atropin]]e 2mg IV OR [[pralidoxime]] 2g IV over 10-15min | ||
==See Also== | ==See Also== | ||
Revision as of 00:39, 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 patients with ongoing ischemia (tachycardia may worsen ischemia)
- 0.5mg q3-5min (max 3mg or 6 doses)
- may not work in 2nd/3rd degree heart block, 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.