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Bradyarrythmias
Bradycardia is defined as any
rhythm disorder with a heart rate
less than 60 beats per minute. This
could also be called asymptomatic
bradycardia.
Bradycardia can be a normal nonemergent rhythm. For instance, well
trained athletes may have a normal
heart rate that is less than 60 bpm.
PR interval >200ms
If accompanied by wide QRS, refer to cardiology,
high risk of progression to 2nd and 3rd deg block
Otherwise, benign if asymptomatic
Symptoms of bradycardia
A heart rhythm that's too slow can
cause insufficient blood flow to the
brain with symptoms such as:
Fatigue Dizziness
Lightheadedness
Fainting or near-fainting spells
In extreme cases, cardiac arrest may
occur.
Causes of bradycardia
Problems with the sinoatrial (SA) node,
sometimes called the heart's natural
pacemaker Problems in the conduction
pathways of the heart (electrical
impulses are not conducted from the
atria to the ventricles)
Metabolic problems such as hypothermia
Damage to the heart from heart attack
or heart disease
Bradycardia Pharmacology
There are 3 medications that are used in the
Bradycardia ACLS Algorithm. They are
atropine,
dopamine
(infusion),
and
epinephrine (infusion)
Atropine: The first drug of choice for
symptomatic bradycardia. Dose in the
Bradycardia ACLS algorithm is 0.5mg IV push
and may repeat up to a total dose of 3mg.
Dopamine:
Second-line
drug
for
symptomatic bradycardia when atropine is
not
effective.
Dosage
is
2-10
micrograms/kg/min infusion.
Epinephrine: Can be used as an equal
alternative to dopamine when atropine is not
effective. Dosage is 2-10 micrograms/min.
2010
AHA
Update:
For
symptomatic bradycardia or unstable
bradycardia IV infusion chronotropic
agents (dopamine & epinephrine) is
now recommended as an equally
effective alternative to external
pacing when atropine is ineffective.
Bradycardia Algorithm
The
decision
point
for
ACLS
intervention
in
the
bradycardia
algorithm is determination of adequate
perfusion.
For
the
patient
with
adequate
perfusion,
you
should
observe and monitor.
If the patient has poor perfusion,
preparation for transcutaneous pacing
should be initiated, and an assessment
of contributing causes (Hs and Ts)
should be carried out.
REMEMBER
For the patient with symptomatic
bradycardia with signs of poor
perfusion, transcutaneous pacing is
the treatment of choice.
NO QRS
=
NO
CIRCULATION
Thank You