ACLS review: Bradycardia part 5

Electrical Capture

·         Electrical capture is observed when a pacer spike is immediately followed by a QRS complex

·         Notice that the QRS complex is wide and there is ST elevation.

Increase mA by 5-10mA Until Electrical Capture is Obtained

Mechanical Capture

·         Improved BP

·         Palpable pulse

·         Improved level of consciousness

·         Improved respiratory status

·         Cessation of chest pain

·         Improvement in skin color

Note:  Pulse rate should equal that of the rate set by the pacemaker.  Monitoring continuous pulse oximetry is a good way of verifying the pulse rae and the oxygen saturation.

Medications

·         Atropine

·         Dopamine infusion

·         Epinephrine infusion

Atropine

·         Use cautiously with wide QRS bradycardia

·         Initial IV dose 0.5

·         Repeat every 3-5minutes

·         Total dose 0.04mg/kg

·         Atropine will not work on denervated hearts (heart transplants). 

·         Atropine may be considered, but if pt is in 2nd degree type II or 3rd degree block, it may extend the block to 3rd degree or asystole.


Reviewed 2/28/16