Bradyarrhythmias

First Things First (assess & treat for the following)

• Bradycardia = ventricular rate < 50-60 bpm
  • Can be normal (sinus bradycardia)
  • Can be abnormal
    • Sinus node dysfunction
    • Conduction block

• Assess hemodynamic status:
  • Is pt hypotensive?
  • Is there evidence of tissue hypoperfusion?
  • Evaluate for CHF.
  • Evaluate for active ischemia.

• If any of the above are yes, then the pt is unstable & requires immediate treatment per ACLS.

• Treatment of SYMPTOMATIC bradycardia
  • Atropine (anticholinergic): 0.5-1 mg
  • Isoproterenol (beta agonist): 2-10 mcg/min
  • Temporary pacing
    • Transcutaneous pacing
    • Transvenous pacing
  • Epinephrine: 2-10 mcg/min
  • Dopamine: 5-20 mcg/min