Bradycardia CPG A0402 Flashcards

Flashcards summarizing key points from the Bradycardia CPG A0402 guideline.

Bradycardia

Heart rate less than 60 beats per minute; consider 50 bpm as a threshold for management.

Atropine

Medication unlikely to be effective in 2nd degree type II (Mobitz II) and 3rd degree (complete) heart block,

but should still be administered. Ineffective and potentially harmful in patients who have had cardiac transplant.

Adrenaline Infusion

Adrenaline 3 mg added to make 50 mL with D5W or Normal Saline; 1 mL/hr = 1 mcg/min. Titrate to patient response.

Atropine Caution

Should be used with caution in myocardial infarction, as increased heart rate may worsen ischemia.

Adrenaline Side Effects

If side effects occur during Adrenaline infusion, cease infusion and recommence once side effects resolve or proceed to pacing.

Atropine Dosage

Atropine 600mcg IV

- repeat 1200mcg (3-5 mins) if inadequate response

Inadequate response

After Atropine 1800mcg

Adrenaline infusion (3mg to 47mls) - 5mcg/ml increase to 10mcg/ml

Inadequate response - extremely poor perfusion

ACS / <50bpm / <60bp

Pacing

Transthoracic pacing

Midazolam 1-2mg & Fentanyl 50mcg IV

pacing 30mA & HR 70/min

Atropine - adequate response

Continue Atropine 600mcg (3-5 min) to max of 3000mcg (x5 doses)

Unstable Bradycardia

Less than adequate perfusion (inc acute STEMI & ischaemic chest pain)

HR <40 & APO

Runs of VT or ventricular escape

HR <20