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Unstable BradycardiaAka: Sinus Arrest
- Signs
- Bradycardia
- Absolute Bradycardia: under 60 bpm
- Relative Bradycardia: inappropriately normal rate
- Hypotensive patient should be tachycardic
- Cardiopulmonary decompensation
- Pediatric
- Poor perfusion
- Hypotension
- Respiratory distress
- Adult
- Chest Pain
- Shortness of Breath
- Decreased Level of Consciousness
- Hypotension and Shock
- Pulmonary congestion
- Congestive Heart Failure
- Acute Myocardial Infarction
- Pediatric
- Bradycardia
- Precautions
- Avoid Lidocaine
- Lethal if Bradycardia is ventricular escape rhythm
- Avoid Lidocaine
- Management: Pediatric
- ABC Management
- Mnemonic: IV-O2-Monitor
- Obtain IV Access
- Oxygen Delivery
- Cardiopulmonary monitor
- Pediatric Vital Signs
- If signs of cardiorespiratory failure despite above
- Chest Compressions for Heart Rate under 60
- Epinephrine every 3-5 minutes
- IV/IO Dose: 0.01 mg/kg (0.1 ml/kg of 1:10,000)
- ET Dose: 0.1 mg/kg (0.1 ml/kg of 1:1000)
- Atropine
- Dose: 0.02 mg/kg IV, IO, or ET
- Minimum Dose: 0.1 mg
- Maximum Dose: 0.5 mg child, 1.0 mg adolescent
- Consider transcutaneous pacing or esophageal pacing
- Observe for change in rhythm (e.g Asystole)
- Management: Adult
- ABC Management
- Mnemonic: IV-O2-Monitor
- Obtain IV Access
- Oxygen Delivery
- Cardiopulmonary monitor
- Vital Signs
- History and Exam
- Electrocardiogram
- Chest XRay
- IF signs of immediate failure present:
- Atropine
- Dose: 0.5-1.0 mg q3-5 min to max total 3 mg
- No response in denervated transplanted hearts
- Transcutaneous pacing
- Dopamine 5-20 mcg/kg/min
- Epinephrine 2-10 mcg/min
- Atropine
- Prepare for Transvenous Pacing if indicated:
- Type II second degree AV Heart Block
- Third degree AV Heart Block
Sinus arrest (C0178428) | |
|---|---|
| Definition (NCI) | A failure of impulse formation in the sinus node. Sinus arrest is indistinguishable from third degree sinoatrial exit block on the standard ECG. |
| Concepts | Pathologic Function (T046) |
| English | ARREST SINUS, SINUS ARREST, Sinus Arrest/Pause, Sinus Pause |
| Spanish | paro sinusal |
| Parent Concepts | Supraventricular arrhythmia (C0428974), Sinus node dysfunction (C0428908) |
| Sources | COSTAR, CST, MTH, NCI, OMIM, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |
Severe sinus bradycardia (C0264890) | |
|---|---|
| Concepts | Disease or Syndrome (T047) |
| ICD9 | 427.81 |
| English | Severe sinus bradycardia |
| Spanish | bradicardia sinusal severa |
| Parent Concepts | Sinus bradycardia (C0085610) |
| Sources | MTHICD9, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |
