Difference between revisions of "ACLS: Bradycardia"

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##[[Epinephrine]] 2-10mcg/min
##[[Epinephrine]] 2-10mcg/min
#'''[[Transcutaneous Pacing]]'''
#'''[[Transcutaneous Pacing]]'''
##Pad placement:
###Pad on apex of heart and 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
#'''Transvenous pacing'''
#'''Transvenous pacing'''
##Required if transcutaneous pacing + chronotropes is ineffective
##Required if transcutaneous pacing + chronotropes is ineffective

Revision as of 14:47, 30 October 2013


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


  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)


  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. B-blocker
    2. Ca-channel blocker
    3. Digoxin toxicity
    4. Opioids
    5. Organophosphates
  5. Infectious/Postinfectious
    1. Chagas dz
    2. Lyme dz
    3. Syphilis


  1. Atropine
    1. Can be used as temporizing measure (while awaiting pacing and/or chronotropes)
    2. Use cautiously in pts w/ ongoing ischemia (tachycardia may worsen ischemia)
    3. 0.5mg q3-5min (max 3 mg or 6 doses)
      1. may not work in 2nd/3rd deg HB, heart transplantTranscutaneous pacing
  2. Chronotropes
    1. Dopamine 2-10mcg/kg/min
    2. Epinephrine 2-10mcg/min
  3. Transcutaneous Pacing
  4. Transvenous pacing
    1. Required if transcutaneous pacing + chronotropes is ineffective
    2. Set: HR 80, start at max current output (usually 20 mA)
      1. Final current set to twice the threshold level for pt

See Also