Difference between revisions of "ACLS: Bradycardia"

(Differential)
Line 19: Line 19:
 
##Vasovagal reflex
 
##Vasovagal reflex
 
##Hypersensitive carotid sinus syndrome
 
##Hypersensitive carotid sinus syndrome
##Intra-abdominal hemorrhage (ruptured ectopic)
+
##Intra-abdominal hemorrhage (i.e. ruptured ectopic)
 
#Metabolic/endocrine/environmental
 
#Metabolic/endocrine/environmental
 
##Hyperkalemia
 
##Hyperkalemia
Line 30: Line 30:
 
##Lyme dz
 
##Lyme dz
 
##Syphilis
 
##Syphilis
 +
 
==Treatment==
 
==Treatment==
 
*Transcutaneous pacing
 
*Transcutaneous pacing

Revision as of 20:45, 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 (i.e. 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