Peri-Arrest Rhythms: Bradycardia

Question 1

what does the management of bradycardia depend on?

Answer 1

1. presence of ‘adverse signs’
2. identifying the potential risk of asystole

Question 2

what are the ‘adverse signs’?

Answer 2

• shock = hypotension, pallor, sweating, cold…
• syncope
• myocardial ischaemia
• heart failure

Question 3

what is the 1st line in a haemodynamically unstable person with bradycardia?

Answer 3

atropine 500mg IV

Question 4

sinus bradycardia + ‘adverse signs’

how do you manage a patient who has not responded to atropine?

Answer 4

1. atropine (max 3mg)
2. transcutaneous pacing
3. isoprenaline/adrenaline infusion

Question 5

what are the risk factors for asystole with bradycardia?

Answer 5

• complete heart block with broad complex QRS
• recent asystole
• mobitz type II AV block
• ventricular pause >3 seconds