Bradycardia

Question 1

First line of medication?
Dose?
Max dose?

Answer 1

Atropine
-1 mg IV every 3-5 minutes (max dose is 3mg)

Question 2

S/S and Causes of Bradycardia

Answer 2

-S/S: Chest pain, SOB, decreased LOC, fatigue, dizzy, syncope, hypotension, diaphoresis, pulmonary congestion, + CHF
-Causes: AV blocks and all H’s/T’s

Question 3

What is considered symptomatic bradycardia?

Answer 3

Symptomatic and HR less than 50 bpm

Question 4

Describe a Second Degree Type I AV Block

Answer 4

PR progressively gets longer until a beat is dropped

Question 5

Describe a Second Degree Type II AV block

Answer 5

-PR is the same length
-Random QRS will be dropped
-atropine will not be affective

Question 6

Describe a Third Degree Block

Answer 6

-more P waves than QRS
-atropine can be ineffective with this arrhythmia as well

Question 7

When to use Epi/Dopamine? Dose?

Answer 7

-when atropine is not effective for unstable Brady
-they are vasoconstrictors, so assess the intravascular volume status and avoid hypovolemia
-Epi: 2-10 mcg/min
-Dopamine: 5-20 mcg/kg/min

Question 8

What is the second line of treatment for unstable bradycardia? How to implement this intervention?

Answer 8

Transcutenous Pacing

-Set pacing to the lowest effective rate based on assessment/ s/s resolution (ex. 60-80/min)
-Conscious patients should be sedated before pacing (ex. Parenteral narcotic, benzo, chronotropic infusion (ex. epi), and obtain expert consultation for TCP)
-Set demand rate to 60-80/min → set milliamperes output 2 mA above the dose at which consistent capture is observed (ex. This is the energy above the dose at which consistent capture is observed)

Question 9

Describe ACLS Brady Algorithm

Answer 9

1. Look for cause (H/T + AV blocks)
2. Establish airway
3. Monitor HR/rhythm/BP w/ pulse ox/capnography
4. IV/IO access
5. Atropine ect. for symptomatic Brady –> EPI/Dopamine if neccessary
6. TCP