Bradycardia and Its Treatment Overview

Bradycardia and Treatment Overview

• Symptomatic bradycardia requires three criteria: slow heart rate, presence of symptoms, and symptoms must be due to the slow heart rate.
• Primary decision point in the ACLS Bradycardia Algorithm is the determination of adequate perfusion.
• In cases of poor perfusion, immediate treatment is necessary.

Atropine Administration

• Correct dosing regimen for atropine: 0.5 mg IV every 3-5 minutes, up to a maximum of 3 mg.
• Atropine must be used cautiously in cardiac ischemia as it may worsen the condition.
• Doses lower than 0.5 mg can paradoxically slow the heart rate.

Transcutaneous Pacing (TCP) Precautions

• TCP is contraindicated in severe hypothermia and not recommended for asystole.
• Conscious patients require analgesia for discomfort during TCP procedures.
• Do not assess carotid pulse for mechanical capture; electrical stimulation may cause muscular jerking.

Steps for Transcutaneous Pacing

• Sequence: Place pacing electrodes on the chest, turn the pacer on, set the demand rate to 60 beats/min (adjust as needed), and set the current output 2 mA above the level for consistent capture.

Treatment Protocols for Bradycardia

• Appropriate treatments under the Adult Bradycardia with a Pulse Algorithm include atropine, dopamine, and epinephrine.
• Initial treatment for bradycardia in cases of poor perfusion is atropine.

Advanced Patient Scenarios

• For a patient with third-degree heart block experiencing chest pain, hypotension, and pulmonary congestion after receiving atropine with minimal effect, additional interventions are needed beyond initial atropine administration.