Bradycardia

Question 1

Clinical features of bradycardia:

Answer 1

HR less than 60
Possible hypotension
Dizziness, mental status changes, nausea/vomiting

Question 2

DDX of bradycardia (CNS)

Answer 2

increased ICP
vagal stimulation
spinal shock

Question 3

DDX of bradycardia: CV

Answer 3

MI
sick sinus syndrome
AV blocks

Question 4

What is sick sinus syndrome?

Answer 4

SA node degeneration leading to bradycardia and often complicated by intermittent SVT

Question 5

DDX of bradycardia: pulmonary

Answer 5

Hypoxemia

Question 6

DDX of bradycardia-metabolic:

Answer 6

acidosis, hypothermia

Question 7

DDX of bradycardia-endocrine

Answer 7

hypothyroidism, adrenal insufficiency

Question 8

DDX of bradycardia: drugs

Answer 8

beta blockers
anesthetic drugs 
K+ (otassium levels above 6,0 mmol/l cause peaked T waves, wider QRS komplexes and may result in bradycardia, asystole and sudden death.)
Ca++ (hypocalcemia) 
digoxin

Question 9

How do you manage bradycardia?

Answer 9

Verify Brady (HR tracing on SpO2, EKG, manual pulse)
Maintain patent airway
confirm rhythm on EKG 
Surgical causes (traction on bowel)

Question 10

If bradycardia starts changing mental status, causing chest pain, or hypotension, then what?

Answer 10

Atropine 0.5 mg IV
epinephrine 10 micrograms to 20 microgram bolus
infusion of epic (2-10 mcg/min)
If refractory to pharmacologic measures, prepare for transcutaneous pacing

Question 11

If bradycardia has mild symptoms (mild-moderate hypotension, nausea/vomiting), then what?

Answer 11

Give atropine 0.4 mg IV
ephedrine 5-10 mg IV
glycopyrrolate 0.2 mg