Advanced Cardiac Life Support - Bradycardias

Bradycardia is defined as heart rate that is less than normal. In adults this means less than 60 beats per minute. There is only a problem with a bradycardia if there are symptoms associated with it. No one would treat Lance Armstrong's resting bradycardia of 32 beats per minute.

Symptoms of bradycardia include:

• Dizziness
• Tiredness
• Shortness of breath
• Palpitations
• Chest pain
• Intolerance to exercise
• Confusion or difficulty concentrating

Signs that the bradycardia may be symptomatic include:

• Low blood pressure, especially when standing
• chest pain
• unstable angina, angina or other sign of an acute myocardial infarction
• PVCs or premature ventricular complexes

The bradycardia algorithm is as follows

• Access primary ABCD
• A secondary ABCD survey should quickly follow
  • Should the patient be intubated?
  • O2, IV access should be obtained
  • Vital signs, oximetry and blood pressure should be obtained
  • A 12 lead ECG should be taken as well as a portable chest x-ray
  • A quick patient history should be given by the patient focusing on the current problem
  • A quick physical exam should be given
  • Consider different causes to this.
• Is there serious signs or symptoms with this bradycardia?
• If the answer to the above is yes then:
  • Atropine should be given at .5 to 1 mg
  • Transcutaneous pacing should be started if available
  • Dopamine should be given at 5-20 ug/kg/min
  • Epinephrine should be given at 2-10 ug/min
  • Isoproterenol should be given at 2-10 ug/min if the patient does not respond to the first four treatments.

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Last Updated 12/12/2005 2:37:28 PM