Adult bradycardia and tachycardia with a pulse: stable versus unstable decisions, atropine, pacing, adenosine, synchronized cardioversion, and narrow versus wide complex management.
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- What heart rate defines bradycardia in adults?
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A heart rate below 60 beats per minute.- What is the first step in managing any symptomatic bradycardia?
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Identify and treat the underlying cause (airway, oxygen, IV access, monitor, treat reversible causes).- What clinical signs make a bradycardia or tachycardia 'unstable'?
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Hypotension, acutely altered mental status, signs of shock, chest pain, and acute heart failure.- What is the first-line drug for symptomatic bradycardia with a pulse?
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Atropine.- What is the initial IV dose of atropine for symptomatic bradycardia?
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1 mg IV push.- How often can the atropine dose be repeated for bradycardia?
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Every 3 to 5 minutes.- What is the maximum total dose of atropine for bradycardia?
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3 mg.- In which type of AV block is atropine likely to be ineffective?
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High-degree block such as Mobitz type II second-degree or third-degree (complete) AV block.- Why might atropine fail to work in a heart transplant patient?
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A transplanted heart is denervated, so it does not respond to vagal blockade from atropine.- If atropine fails or is not appropriate for unstable bradycardia, what are the next treatment options?
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Transcutaneous pacing, a dopamine infusion, or an epinephrine infusion.- What is the dopamine infusion dose range used for bradycardia?
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About 5 to 20 micrograms per kilogram per minute.- What is the epinephrine infusion dose range used for bradycardia?
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About 2 to 10 micrograms per minute.- What device-based treatment is used for unstable bradycardia that does not respond to atropine?
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Transcutaneous pacing.- Why should a conscious patient receiving transcutaneous pacing be given sedation or analgesia first?
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Transcutaneous pacing causes significant discomfort from skeletal muscle contraction.- What should be prepared in advance for a heart transplant patient with unstable bradycardia?
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Transcutaneous pacing or catecholamine infusions, since atropine is likely ineffective.
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