Bradycardia resident survival guide: Difference between revisions

Revision as of 17:21, 22 August 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Definition

Sinus bradycardia is defined as a sinus rhythm with a rate below 60 beats per minute.

Causes

Life Threatening Causes

Life-threatening conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Management

Assess appropriateness for clinical condition.Heart rate typically < 50/min if bradyarrhythima

Identify and treat underlying cause

Maintain patent airway; assist breathing as necessary
Oxygen (if hypoxemic)
Cardiac monitor to identify rhythm;
Monitor blood pressure and oximetry
IV access
12-Lead ECG if available; don’t delay therapy

Persistent bradyarhythmia causing:

Hypotension?
Acutely altered mental status?
Signs of shock?
Ischemic chest discomfort?

Acute heart failure?

Yes

No

Atropines first dose 0.5 mg iv bolus, repeat every 3-5 minutes
Maximum: 3 mg If atropine ineffective:Transcutaneous Pacing OR Dopamine infusion (2-10 mcg/kg/min) OR Epinephrine infusion (2-10 mcg/min)

Monitor and observe

Do's

Don'ts

References

Template:WH Template:WS

@@ Line 50: / Line 50: @@
 ==Management==
+{{Family tree/start}}
+{{Family tree | | | | A01 | | | |A01=Assess appropriateness for clinical condition.Heart rate typically < 50/min if bradyarrhythima}}
+{{Family tree | | | | |!| | | | | }}
+{{Family tree | | | | B01 | | | |B01=Identify and treat underlying cause
+* Maintain patent airway; assist breathing as necessary
+* Oxygen (if hypoxemic)
+* Cardiac monitor to identify rhythm;
+* Monitor blood pressure and oximetry
+* IV access
+* 12-Lead ECG if available; don’t delay therapy}}
+{{Family tree | | | | |!| | | | | }}
+{{Family tree | | | | C01 | | | |C01=Persistent bradyarhythmia causing:
+* Hypotension?<BR>
+* Acutely altered mental status?
+* Signs of shock?
+* Ischemic chest discomfort?
+*Acute heart failure?}}
+{{Family tree | |,|-|-|^|-|-|.| | }}
+{{Family tree | D01 | | | | D02 |D01= Yes| D02= No}}
+{{Family tree | |!| | | | | |!| | }}
+{{Family tree | E01 | | | | E02 |E01= Atropines first dose 0.5 mg iv bolus, repeat every 3-5 minutes <BR> Maximum:  3 mg If atropine ineffective:Transcutaneous Pacing  OR Dopamine infusion (2-10 mcg/kg/min) OR Epinephrine infusion (2-10 mcg/min)|E02= Monitor and observe}}
+{{Family tree/end}}
 ==Do's==