ACLS: Bradycardia: Difference between revisions

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''This page is for bradycardia with a pulse; for bradycardia without a pulse see [[Adult Pulseless Arrest]] (i.e. PEA)''
''This page is for bradycardia with a pulse; for bradycardia without a pulse (i.e. PEA) see [[Adult pulseless arrest]]''


==Background==
==Background==
*HR < 60
*HR < 60
*Intervention only necessary if patient is symptomatic (hypotension, AMS, chest pain, pulmonary edema)
*Intervention only necessary if patient is symptomatic (hypotension, altered mental status, chest pain, pulmonary edema)


==Categories==
==Categories==
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**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 patients with ongoing ischemia (tachycardia may worsen ischemia)
**Use cautiously in patients with ongoing ischemia (tachycardia may worsen ischemia)
**Avoid and/or do not rely on in wide complex bradycardia, especially in setting of ischemia<ref>Neumar RW et al. Part 8: Adult Advanced Cardiovascular Life Support. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.</ref>
**0.5mg q3-5min (max 3mg or 6 doses)
**0.5mg q3-5min (max 3mg or 6 doses)
***May not work in 2nd/3rd degree heart block, heart transplant
***May not work in 2nd/3rd degree heart block, heart transplant
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***Block is below AV node so atropine will accelerate sinus rate, leading to worsening of block and increased fatigue of AV nodal cells
***Block is below AV node so atropine will accelerate sinus rate, leading to worsening of block and increased fatigue of AV nodal cells
*'''Chronotropes'''
*'''Chronotropes'''
**[[Dopamine]] 2-10mcg/kg/min
**[[Dopamine]] 2-10 mcg/kg/min, max 50 mcg/kg/min
**[[Epinephrine]] 2-10mcg/min
**[[Dobutamine]] 2-20 mcg/kg/min, max 40 mcg/kg/min
**[[Epinephrine]] 2-10 mcg/min (~0.03-0.2 mcg/kg/min, max 1 mcg/kg/min)
**[[Isoproterenol]] 2-10 mcg/min
*'''[[Transcutaneous Pacing]]'''
*'''[[Transcutaneous Pacing]]'''
*'''[[Transvenous Pacing]]'''
*'''[[Transvenous Pacing]]'''
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==External Links==
==External Links==
*[http://ddxof.com/simplified-acls-algorithms/ DDxOf: Simplified ACLS Algorithms]
*[http://ddxof.com/simplified-acls-algorithms/ DDxOf: Simplified ACLS Algorithms]
==Video==
{{#widget:YouTube|id= dKqAqC6JEYQ}}


==References==
==References==

Revision as of 23:52, 8 August 2018

This page is for bradycardia with a pulse; for bradycardia without a pulse (i.e. PEA) see Adult pulseless arrest

Background

  • HR < 60
  • Intervention only necessary if patient is symptomatic (hypotension, altered mental status, chest pain, pulmonary edema)

Categories

  • Sinus node dysfunction
  • 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 Diagnosis

Symptomatic bradycardia

Management

Algorithm for bradycardia with a pulse (Adapted from ACLS 2010)
  • Atropine
    • Can be used as temporizing measure (while awaiting pacing and/or chronotropes)
    • Use cautiously in patients with ongoing ischemia (tachycardia may worsen ischemia)
    • Avoid and/or do not rely on in wide complex bradycardia, especially in setting of ischemia[1]
    • 0.5mg q3-5min (max 3mg or 6 doses)
      • May not work in 2nd/3rd degree heart block, heart transplant
      • Priority is to use external cardiac pacemaking[2]
      • Block is below AV node so atropine will accelerate sinus rate, leading to worsening of block and increased fatigue of AV nodal cells
  • Chronotropes
  • Transcutaneous Pacing
  • Transvenous Pacing

Antidotes for toxicologic causes

See Also

External Links

Video

{{#widget:YouTube|id= dKqAqC6JEYQ}}

References

  1. Neumar RW et al. Part 8: Adult Advanced Cardiovascular Life Support. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
  2. Burns, E. AV block: 3rd degree (complete heart block). http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/