ACLS: Bradycardia: Difference between revisions
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##Pad placement: | ##Pad placement: | ||
###Pad on apex of heart and other on R upper chest | ###Pad on apex of heart and other on R upper chest | ||
###Pad on lead V3 position and btwn L scapula and T-spine##Set: HR 80, pacing threshold usually btwn 40-80 mA | ###Pad on lead V3 position and btwn L scapula and T-spine | ||
##Set: HR 80, pacing threshold usually btwn 40-80 mA | |||
###Look for clear QRS complex and T-wave following pacer spike | ###Look for clear QRS complex and T-wave following pacer spike | ||
###Check pulse to confirm mechanical capture | ###Check pulse to confirm mechanical capture |
Revision as of 21:14, 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 (Osborn waves on ECG)
- Hypothyrodism
- Toxicologic
- Digoxin toxicity
- Infectious/Postinfectious
- Chagas dz
- Lyme dz
- Syphilis
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 transplantTranscutaneous pacing
- Chronotropes
- Dopamine 2-10mcg/kg/min
- Epinephrine 2-10mcg/min
- Transcutaneous pacing
- Pad placement:
- Pad on apex of heart and other on R upper chest
- Pad on lead V3 position and btwn L scapula and T-spine
- Set: HR 80, pacing threshold usually btwn 40-80 mA
- Look for clear QRS complex and T-wave following pacer spike
- Check pulse to confirm mechanical capture
- Final current set 5-10 mA above threshold level for pt
- Pad placement:
- Transvenous pacing
- Required if transcutaneous pacing + chronotropes is ineffective
- Set: HR 80, max current output (usually 20 mA)
- Final current set to twice the threshold level for pt