Tuesday, September 24, 2013

Symptomatic Bradycardia in Cardiovascular Emergencies

          Bradycardia in Cardiovascular Emergencies is when heart rate < 60 beats per minute and inadequate for clinical condition. So what would you do as a Doctor or paramedic to treat this condition? There are step which must done: SSSSSlow

1. Stable: Is the patient hemodynamically unstable?
2. Symptoms: Does the patient have symptoms related to the bradycardia? If a patient is hypotensive or having symptoms of bradycardia at rest, particularly syncope, immediate action must be taken.
         - Assess airway, breathing, and circulation (ABCs).
         - Place a monitor/defibrilator on the patient, ideally with transcutaneous pacing pads.
         - Ensure adequate intravenous acess and oxygenation
3. Source: Where in the conduction system is the dysfunction?
         - A brief review of the rhythm strip or ECG important.
         - Advanced atrioventricular block is unlikey to respond the increased atrial heart rates that
           atropine provides and will likely need urgent pacing.
4. Speed up the heart: Medical therapy: atropine, then dopamine or epinephrine if necessary.
         - Atropine (0,5 - 1 mg IV). Doses can be repeated every 3 to 5 minutes. The exception to using 
           is AV Block type II second degree, which may be worsened by atropine. If intravenous access 
           is not available, atropine may be given through an endotracheal tube (1-2 mg diluted to a total
           not to exceed 10 mL of sterile water or normal saline).
         - Dopamine, 2 to 10 µg/kg per minute IV, to keep systolic blood pressure >90 mm Hg
         - Epinephrine, 2 to 10 µg per minute IV, to keep systolic blood pressure >90 mm Hg
5. Set up for Peacemaker: Get transcutaneous and/ or transvenous pacemaker system ready.
        - Transcutaneous pacing. Place pads on the anterior and posterior chest walls. Initially begin 
           pacing at the highest output. Rapidly reduce the output until regular capture is seen. If 
           hypotension is not severe. sedate the patient.
        - Prepare for transvenous pacing.

6 comments:

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