Page 85 - Radiology Book

bradycardia
ACLS Healthcare Provider - 2015 Update
Absolute Bradycardia: Heart rate <60 beats per minute. Relative Bradycardia: Heart rate less than expected in clinical
situation.
Treat the patient, not the monitor. Patients with symptomatic bradycardia may be “pre-cardiac arrest” and may merit multiple interventions simultaneously
(ie, transcutaneous pacing, IVFs, cardiology consult, atropine dose, dopamine or epinephrine infusion).
PRIMARY EVALUATION
· Airway · Vitals
· Monitor · EKG
SIGNS OF INSTABILITY
· Altered mental status · Ischemic chest pain · Shock
· Hypotension
· Heart failure
UNSTABLE? Signs and symptoms due to bradycardia?
83
NO
Monitor and observe
Type II second-degree AV block
OR
Third-degree AV block?
BLOCK PRESENT?
YES
Atropine
NO
· Observe · Look for
underlying causes
YES
· IV dose: 0.5–1 mg bolus
· Repeat every 3–5 minutes · Maximum 3 mg
If atropine is ineffective
· Transcutaneous pacing OR
· Dopamine infusion 2–10 μg/kg/min OR
· Epinephrine infusion 2–10 μg/min
· Prepare transvenous pacer
· Use transcutaneous pacemaker to maintain patient
until transvenous pacer placement
· Transcutaneous pacing is a temporizing measure at best.
· Transcutaneous pacing is painful in conscious patients.
· Whether effective or not, the patient should be prepped for transvenous pacing
with cardiology.
· Atropine administration should not delay external pacing implementation for
patients with poor perfusion.
· Use atropine cautiously in the presence of acute coronary ischemia or MI.
Increased heart rate may worsen ischemia or increase infarct size.
Consistent with and in respect to 2015 American Heart Association Guidelines. See latest algorithm at: https://eccguidelines.heart.org
ACLS