Difference between revisions of "ACLS: Bradycardia"

(Differential)
Line 5: Line 5:
  
 
==Categories==
 
==Categories==
#'''Sinus node dysfunction'''
+
*'''Sinus node dysfunction'''
##Sinus bradycardia
+
**Sinus bradycardia
##Sinus arrest
+
**Sinus arrest
##[[Tachy-Brady Syndrome]] ([[Sick Sinus]])
+
**[[Tachy-Brady Syndrome]] ([[Sick Sinus]])
##Chronotropic incompetence
+
**Chronotropic incompetence
#'''AV node dysfunction'''
+
*'''AV node dysfunction'''
##1st degree AV block
+
**1st degree AV block
##2nd degree AV block Mobitz I/Wenckebach
+
**2nd degree AV block Mobitz I/Wenckebach
##2nd degree AV block Mobitz II
+
**2nd degree AV block Mobitz II
##3rd degree AV block (complete heart block)
+
**3rd degree AV block (complete heart block)
  
 
==Differential==
 
==Differential==
#'''Ischemia/Infarction'''
+
*'''Ischemia/Infarction'''
##Inferior MI (involving RCA)
+
**Inferior MI (involving RCA)
#'''Neurocardiogenic/reflex-mediated'''
+
*'''Neurocardiogenic/reflex-mediated'''
##Increased ICP
+
**Increased ICP
##Vasovagal reflex
+
**Vasovagal reflex
##Hypersensitive carotid sinus syndrome
+
**Hypersensitive carotid sinus syndrome
##Intra-abdominal hemorrhage (i.e. ruptured ectopic)
+
**Intra-abdominal hemorrhage (i.e. ruptured ectopic)
#'''Metabolic/endocrine/environmental'''
+
*'''Metabolic/endocrine/environmental'''
##Hyperkalemia
+
**Hyperkalemia
##Hypothermia (Osborn waves on ECG)
+
**Hypothermia (Osborn waves on ECG)
##Hypothyrodism
+
**Hypothyrodism
##Hypoglycemia (neonates)
+
**Hypoglycemia (neonates)
#'''Toxicologic'''
+
*'''Toxicologic'''
##B-blocker
+
**B-blocker
##Ca-channel blocker
+
**Ca-channel blocker
##Digoxin toxicity
+
**Digoxin toxicity
##Opioids
+
**Opioids
##Organophosphates
+
**Organophosphates
#'''Infectious/Postinfectious'''
+
*'''Infectious/Postinfectious'''
##Chagas dz
+
**Chagas dz
##Lyme dz
+
**Lyme dz
##Syphilis
+
**Syphilis
#[[Sick Sinus Syndrome]]
+
*[[Sick Sinus Syndrome]]
  
 
==Treatment==
 
==Treatment==
#'''Atropine'''
+
*'''Atropine'''
##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 (max 3 mg or 6 doses)
+
**0.5mg q3-5min (max 3 mg or 6 doses)
###may not work in 2nd/3rd deg HB, heart transplant
+
***may not work in 2nd/3rd deg HB, heart transplant
#'''Chronotropes'''
+
*'''Chronotropes'''
##Dopamine 2-10mcg/kg/min
+
**Dopamine 2-10mcg/kg/min
##[[Epinephrine]] 2-10mcg/min
+
**[[Epinephrine]] 2-10mcg/min
#'''[[Transcutaneous Pacing]]'''
+
*'''[[Transcutaneous Pacing]]'''
#'''[[Transvenous Pacing]]'''
+
*'''[[Transvenous Pacing]]'''
  
 
===Antidotes for toxicologic causes===
 
===Antidotes for toxicologic causes===
Line 75: Line 75:
  
 
==References==
 
==References==
#Semelka, M et al. Sick Sinus Syndrome: A Review. Am Fam Physician. 2013 May 15;87(10):691-696.http://www.aafp.org/afp/2013/0515/p691.html#afp20130515p691-t2.
+
*Semelka, M et al. Sick Sinus Syndrome: A Review. Am Fam Physician. 2013 May 15;87(10):691-696.http://www.aafp.org/afp/2013/0515/p691.html*afp20130515p691-t2.

Revision as of 00:37, 7 June 2015

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

Background

  • Only intervene if pt is symptomatic (hypotension, AMS, chest pain, pulm 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

  • 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 (Osborn waves on ECG)
    • Hypothyrodism
    • Hypoglycemia (neonates)
  • Toxicologic
    • B-blocker
    • Ca-channel blocker
    • Digoxin toxicity
    • Opioids
    • Organophosphates
  • Infectious/Postinfectious
    • Chagas dz
    • Lyme dz
    • Syphilis
  • Sick Sinus Syndrome

Treatment

  • 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
  • Chronotropes
  • Transcutaneous Pacing
  • Transvenous Pacing

Antidotes for toxicologic causes

See Also

References