EMS A to Z: Bradydysrhythmias

Show Notes:

From your hosts, Dr. Josh Gaither, Dr. Amber Rice, and Dr. Rachel Munn

 

How may these patients present? (Hint: Vaguely)

Palpitations

Chest pain

Dyspnea

Lightheadedness / dizziness

Altered mental status

Syncope

Weakness / fatigue

Nausea 

How should we assess these patients? 

Patient characteristics/history

Patient appearance

Mental status

General appearance (pale, diaphoretic, cyanotic)

Vital signs

ECG

Rate

Rhythm / regularity

QRS complex 

What are potential causes of bradycardia?  

Coronary artery disease / MI

Ischemia can affect the AV node, electrical conduction system causing bradycardia

Medication effects

Calcium channel blockers, beta-blockers

Electrolytes

Hyperkalemia 

Types of bradycardia: 

Sinus bradycardia

AV block

Junctional / ventricular rhythms

How should we treat these patients? 

Unstable patients:

Transcutaneous pacing

Pad placement: anterior-posterior if able

Starting joules: can start low and titrate up to capture

Target rate: 70 - 80

Electrical capture can be seen on the ECG monitor with pacing spikes followed by wide complexes

Mechanical capture occurs with electrical capture + palpable and perfusing pulse

Medications such as midazolam can be used for sedation if patient’s BP improves and will tolerate

Stable patients:

Truly stable patients may just require monitoring and transport, however if having soft pressures, but not truly unstable, can trial meds:

Atropine

5mg IV/IO trial 

Dopamine

2-10 mcg/kg/min titrating to HR / SBP 

 

Credits:

Music: Scott Holmes Music

Sound effect: zapsplat.com