unstable BradyCardia

KEY UNSTABLE MANAGEMENT PEARLS

• Bradycardia has intrinsic and extrinsic causes that ultimately impair cardiac conduction and output

• If unstable, goal is to increase heart rate to provide adequate cardiac output using atropine, adrenergic medications, and temporary pacing until the etiology is found and treated

• Atropine will not work for non-parasympathetic causes of bradycardia or any conduction interruption below the AV node, consider using epinephrine

• Treat the patient, not the number

• Bradycardia secondary to hyperkalemia, hypothermia, hypoglycemia, or hypothyroidism will not respond effectively to standard ACLS therapies. Treat the underlying cause.

• Always consider hyperkalemia and treat with empiric calcium when thought to be a potential cause

• Note the atrial rate (P waves), ventricular rate (QRS), and P-QRS association (PR-interval beat to beat). Pay attention to the width of the QRS, and the rate variation (regular or irregular)

• Narrow QRS bradycardias are typically vagally induced and have a better prognosis. They rarely require pacing.