Bradycardia

1) First Steps: IV, O2, Monitors, ECG, Pads on patient, Crash Cart in room. Is patient unstable?

 • Unstable: HR generally < 50, Progressively worsening brady, Signs of Shock, SBP <90, AMS, SOB from CHF, Chest Pain

 • ECG: Bad block? Ischemia? HyperK?

2) Give Meds

 • Atropine 0.5mg IV q3-5min, max 3mg

 • Epi 2-20mcg/min IV

 • Dopamine 2-20mcg/kg/min IV

 • Isuprel 2-10mcg/min IV

Set up Transcutaneous Pacing:

 1. Pads in AP position. Connect ECG Leads.

 2. Set pacemaker to Demand mode.

 3. Turn rate to 30bpm above intrinsic rate (start 60bpm).

 4. Set mA to 70 (estimate: 1 mA/kg).

 5. Start pacing. Increase by 5mA/q few seconds until pacing rate captured on monitor. Then increase to 10% above this level (usually 5-10 mA above). 

 6. Confirm mechanical capture.

 7. Administer sedative & pain medication.

3) Consider DDx - Don't Let your Patients DIE: Drugs, Ischemia, Electrolytes



- Dr. Sarah Foohey @SarahFoohey



#bradycardia #diagnosis #differential #management #cardiology