Bradycardia With a Pulse Algorithm

Question 1

What typically is an appropriate HR to consider initiating bradycardia treatment?

Answer 1

Typically < 50

Question 2

First consideration in treating a pt with a brady rhythm?

Answer 2

Treat underlying cause (IICP?)

1. Airway and Breathing
2. Oxygenation (hypoxemia?) O2 sat
3. BP >90
4. 12 lead (rhythm, rate)
5. IV

Question 3

What is considered symptomatic bradycardia?

Answer 3

Rate < 50 and any of the following:

1. Hypotension
2. Acutely AMS
3. Signs of shock (pale, cool, diaphoretic, fever, increased RR, thready pulse)
4. Ischemic CPx
5. Acute heart failure

Question 4

Pharmacological Treatment considerations for symptomatic bradycardia

Answer 4

Medicine:
1. Atropine: 1st dose = .5mg IV bolus, repeat every 3-5 min as needed, total max dose = 3mg
or
2. Dopamine: 2-10mcg/kg/min
or
3. Epinephrine: 2-10mcg/kg/min
Edison:
Transcutaneous pacing

Question 5

Indications for Transcutaneous Pacing (TCP)

Answer 5

1. Unstable bradycardia < 50 (hypotension, AMS, Shock, CPx, acute heart failure), unresponsive to drug therapy
2. AMI with:
   a. symptomatic SA node dysfunction
   b. 2nd degree type II or 3rd degree block
   c. new BBB
   d. symptomatic bradycardia with ventricular escape rhythm
   e. not recommended for agonal rhythms or cardiac arrest

Question 6

Precautions for TCP

Answer 6

1. Concious pt may need analgesics

2. Confirm mechanical capture by palpating a pulse (not the carotid)

Question 7

Technique for TCP

Answer 7

1. Electrodes places per package instructions
2. Turn pacer on
3. Set rate to about 80 bpm
4. Set current: increase from minimum setting until consistent capture achieved (widening QRS and broad T wave after each pacer spike)