ACLS review: Bradycardia part 3

Primary Survey

·         Assess ABCs

·         Breathing-secure noninvasive airway

·         Call for monitor/defibrillator

Note:

Because hypoxemia is a common cause of bradycardia, initial evaluation of any patient with bradycardia should focus on signs of increased work of breathing (tachypnea, intercostal retractions, suprasternal retractions, paradoxical abdominal breathing) and oxyhemoglobin saturation as determined by pulse oximetry

Secondary Survey

·         Oxygen

·         IV access-fluids

·         Vital signs, pulse oximeter, BP

·         Obtain 12 lead

·         Differential diagnosis

Bradycardia Intervention Mnemonic: PACE

P- pacemaker

A-atropine

C-chronotrophic drugs

E-evaluate Hs&Ts

Indications for TCP Pacing

·         Standby for clinically stable bradycardia

·         Therapeutic bridge until placement of a transvenous

·         Hemodynamically unstable bradycardia

 

Note: TCP is, at best, a temporizing measure. TCP is painful in conscious patients, and, whether effective or not (achieving inconsistent capture), the patient should be prepared for transvenous pacing and expert consultation should be obtained

Reviewed 2/28/16