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 | ||
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
- 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
- Hypothyrodism
- Toxicologic
- Digoxin toxicity
- Infectious/Postinfectious
- Chagas dz
- Lyme dz
- Syphilis
Treatment
- Transcutaneous pacing
- Chronotropes
- Dopamine 2-10mcg/kg/min
- Epinephrine 2-10mcg/min
- 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