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
