EM Clerkship

Round 19 (Bradycardia)

03.01.2021 - By Zack Olson, MD and Michael Estephan, MDPlay

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CAUTION: THESE NOTES CONTAIN SPOILERS!!!

Case Introduction

You are working a shift at EM Clerkshift General when you are called to the resuscitation bay to see an elderly patient with unstable vitals brought in by EMS.

Initial Vitals

* Temp 98.0F* HR 43* RR 18* BP 60/40* O2 98%

Critical Actions

* Diagnose the etiology for the bradycardia (BB overdose)* Administer Atropine* Administer Glucagon* Administer Epinephrine drip* Attempt transcutaneous/transvenous pacing* Administer high-dose Insulin therapy

Final Diagnosis

Beta Blocker Overdose

Tips and Tricks

* Keep in mind the broad differential for severe bradycardia – ischemia, ingestion, electrolyte abnormalities, intrinsic arrhythmia/heart block, hypothyroidism, hypothermia, hypoglycemia, hypoxia, increased intracranial pressure, neurogenic shock.

Further Reading

High Dose Insulin Therapy (EMCRIT)

Low and Slow Poisoning (EMCASES)

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