ACLS: Bradycardia: Difference between revisions
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==Differential== | ==Differential== | ||
*'''Ischemia/Infarction''' | *'''Ischemia/Infarction''' | ||
**Inferior MI (involving RCA) | **Inferior [[MI]] (involving RCA) | ||
*'''Neurocardiogenic/reflex-mediated''' | *'''Neurocardiogenic/reflex-mediated''' | ||
**Increased ICP | **[[Increased ICP]] | ||
**Vasovagal reflex | **Vasovagal reflex | ||
**Hypersensitive carotid sinus syndrome | **Hypersensitive [[carotid sinus syndrome]] | ||
**Intra-abdominal hemorrhage (i.e. ruptured ectopic) | **Intra-abdominal hemorrhage (i.e. [[ruptured ectopic]]) | ||
*'''Metabolic/endocrine/environmental''' | *'''Metabolic/endocrine/environmental''' | ||
**Hyperkalemia | **[[Hyperkalemia]] | ||
**Hypothermia (Osborn waves on ECG) | **[[Hypothermia]] (Osborn waves on ECG) | ||
**Hypothyrodism | **[[Hypothyrodism]] | ||
**Hypoglycemia (neonates) | **[[Hypoglycemia]] (neonates) | ||
*'''Toxicologic''' | *'''Toxicologic''' | ||
**B-blocker | **[[B-blocker]] | ||
**Ca-channel blocker | **[[Ca-channel blocker]] | ||
**Digoxin toxicity | **[[Digoxin toxicity]] | ||
**Opioids | **[[Opioids]] | ||
**Organophosphates | **[[Organophosphates]] | ||
*'''Infectious/Postinfectious''' | *'''Infectious/Postinfectious''' | ||
**Chagas | **[[Chagas disease]] | ||
**Lyme | **[[Lyme disease]] | ||
**Syphilis | **[[Syphilis]] | ||
*[[Sick Sinus Syndrome]] | *[[Sick Sinus Syndrome]] | ||
Revision as of 01:04, 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
- 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
- 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
- Naloxone 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.