ACLS: Bradycardia: Difference between revisions

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##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
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##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