ACLS: Bradycardia: Difference between revisions
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==Background== | ==Background== | ||
* | *HR < 60 | ||
*Intervention only necessary if pt is symptomatic (hypotension, AMS, chest pain, pulm edema) | |||
==Categories== | ==Categories== | ||
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**3rd degree AV block (complete heart block) | **3rd degree AV block (complete heart block) | ||
==Differential== | ==Differential Diagnosis== | ||
*'''Ischemia/Infarction''' | *'''Ischemia/Infarction''' | ||
**Inferior [[MI]] (involving RCA) | **Inferior [[MI]] (involving RCA) | ||
| Line 42: | Line 43: | ||
==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 | |||
***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]] 2-10mcg/kg/min | |||
**[[Epinephrine]] 2-10mcg/min | |||
*'''[[Transcutaneous Pacing]]''' | |||
*'''[[Transvenous Pacing]]''' | |||
===Antidotes for toxicologic causes=== | ===Antidotes for toxicologic causes=== | ||
*[[Beta-Blocker Toxicity]] | *[[Beta-Blocker Toxicity]] | ||
** | **Glucagon 5mg IV Q10min (rpt up to 3 doses) | ||
**Insulin 1U/kg bolus | |||
**Intralipid (ILE) | |||
*[[Calcium Channel Blocker Toxicity]] | *[[Calcium Channel Blocker Toxicity]] | ||
**[[Calcium gluconate]] 3g | **[[Calcium gluconate]] 3g | ||
**Insulin 1U/kg bolus | |||
**Intralipid (ILE) | |||
*[[Digoxin Toxicity]] | *[[Digoxin Toxicity]] | ||
**[[Dig immune Fab]] 10-20 vials | **[[Dig immune Fab]] 10-20 vials | ||
| Line 65: | Line 70: | ||
**[[Naloxone]] 0.4mg IV | **[[Naloxone]] 0.4mg IV | ||
*[[Organophosphate Toxicity]] | *[[Organophosphate Toxicity]] | ||
**[[Atropine]] 2mg IV | **[[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)]] | ||
==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. | |||
[[Category:Cards]] | [[Category:Cards]] | ||
[[Category:Critical Care]] | [[Category:Critical Care]] | ||
[[Category:EMS]] | [[Category:EMS]] | ||
Revision as of 22:52, 12 July 2015
This page is for bradycardia with a pulse; for bradycardia without a pulse see Adult Pulseless Arrest (i.e. PEA)
Background
- HR < 60
- Intervention only necessary 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 Diagnosis
- 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)
- Hypothyroidism
- Hypoglycemia (neonates)
- Toxicologic
- Infectious/Postinfectious
- 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
- Priority is to use external cardiac pacemaking[1]
- 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 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)
- 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
References
- ↑ Burns, E. AV block: 3rd degree (complete heart block). http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/
- 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.