Difference between revisions of "ACLS: Bradycardia"

(Antidotes for toxicologic causes)
(Differential)
Line 18: Line 18:
 
==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 disease]]
**Lyme dz
+
**[[Lyme disease]]
**Syphilis
+
**[[Syphilis]]
 
*[[Sick Sinus Syndrome]]
 
*[[Sick Sinus Syndrome]]
  

Revision as of 01:04, 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

Treatment

  1. Atropine
    • Can be used as temporizing measure (while awaiting pacing and/or chronotropes)
    • Use cautiously in patients with ongoing ischemia (tachycardia may worsen ischemia)
    • 0.5mg q3-5min (max 3mg or 6 doses)
      • may not work in 2nd/3rd degree heart block, heart transplant
  2. Chronotropes
  3. Transcutaneous Pacing
  4. Transvenous Pacing

Antidotes for toxicologic causes

See Also

References