ACLS review: Bradycardia part 7

Evaluate:  5Hs & 5Ts

·         Hypoxia

·         Hypovolemia

·         Hyper/hypokalemia

·         Hydrogen ions (acidosis)

·         Hypothermia

Evaluate:  5Hs & 5Ts

·         Tension pneumothorax

·         Thrombosis: coronary

·         Thrombosis: pulmonary

·         Thrombosis: Tables/toxins

·         Tamponade, cardiac

Hypoxia

·         Hypoventilation and hypoxia can lead to bradycardia

·         Assess ABCs

·         Give supplemental oxygen

·         Consider advanced airway management

·         Mechanical Ventilation

Hydrogen Ions (acidosis)

·         Assess ABGs

· ·Treat respiratory acidosis with ventilation

·         Bicarb 1mEq/kg

o   Known pre-existing bicarbonate responsive acidosis

o   Intubated patient with continued long arrest interval

o   Tricyclic antidepressant or aspirin overdose

o   Known prexisting hyperkalemia

Hyperkalemia

·         Bradycardia with tall T waves, widened QRS

·         Assess serum potassium levels

o   3.5-5.3       Normal

o   5.3-6.0       Mild

o   6.1-7.0       Moderate

o   >7.0           Severe

· Rule of 10

10ml of 10% calcium chloride or gluconate IV

10 units of regular insulin IV

One amp D50 over 10 minutes

· Kayexalate orally or rectally

· Lasix IV


Reviewed 2/28/16