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Unstable Bradycardia
- 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
- Precautions
- Avoid Lidocaine
- Lethal if Bradycardia is ventricular escape rhythm
- 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
- Prepare for Transvenous Pacing if indicated:
- Type II second degree AV Heart Block
- Third degree AV Heart Block
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