Difference between revisions of "ACLS: Bradycardia"

(Differential)
(Treatment)
Line 39: Line 39:
 
**Can be used as temporizing measure (while awaiting pacing and/or chronotropes)
 
**Can be used as temporizing measure (while awaiting pacing and/or chronotropes)
 
**Use cautiously in pts w/ ongoing ischemia (tachycardia may worsen ischemia)
 
**Use cautiously in pts w/ ongoing ischemia (tachycardia may worsen ischemia)
**0.5mg q3-5min
+
**0.5mg q3-5min (max 3 mg or 6 doses)
 +
***may not work in 2nd/3rd deg HB, heart transplant
 
*Transvenous pacing
 
*Transvenous pacing
 
**Required if transcutaneous pacing + chronotropes is ineffective
 
**Required if transcutaneous pacing + chronotropes is ineffective

Revision as of 21:01, 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 (Osborn waves on ECG)
    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 (max 3 mg or 6 doses)
      • may not work in 2nd/3rd deg HB, heart transplant
  • Transvenous pacing
    • Required if transcutaneous pacing + chronotropes is ineffective

See Also