Difference between revisions of "ACLS: Bradycardia"

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##2nd degree AV block Mobitz II
 
##2nd degree AV block Mobitz II
 
##3rd degree AV block (complete heart block)
 
##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 (ruptured ectopic)
 +
#Metabolic/endocrine/environmental
 +
##Hyperkalemia
 +
##Hypothermia
 +
##Hypothyrodism
 +
#Toxicologic
 +
##Digoxin toxicity
 +
#Infectious/Postinfectious
 +
##Chagas dz
 +
##Lyme dz
 +
##Syphilis
 
==Treatment==
 
==Treatment==
 
*Transcutaneous pacing
 
*Transcutaneous pacing

Revision as of 20:41, 29 October 2013

Background

  • Only intervene if pt is symptomatic (hypotension, AMS, chest pain, pulm edema)

Categories

  1. Sinus node dysfunction
    1. Sinus bradycardia
    2. Sinus arrest
    3. Tachy-brady syndrome (sick sinus)
    4. Chronotropic incompetence
  2. AV node dysfunction
    1. 1st degree AV block
    2. 2nd degree AV block Mobitz I/Wenckebach
    3. 2nd degree AV block Mobitz II
    4. 3rd degree AV block (complete heart block)

Differential

  1. Ischemia/Infarction
    1. Inferior MI (involving RCA)
  2. Neurocardiogenic/reflex-mediated
    1. Increased ICP
    2. Vasovagal reflex
    3. Hypersensitive carotid sinus syndrome
    4. Intra-abdominal hemorrhage (ruptured ectopic)
  3. Metabolic/endocrine/environmental
    1. Hyperkalemia
    2. Hypothermia
    3. Hypothyrodism
  4. Toxicologic
    1. Digoxin toxicity
  5. Infectious/Postinfectious
    1. Chagas dz
    2. Lyme dz
    3. Syphilis

Treatment

  • Transcutaneous pacing
  • Chronotropes
  • 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
  • Transvenous pacing
    • Required if transcutaneous pacing + chronotropes is ineffective

See Also