EMERGENCY MEDICINE GUIDEWIRE
  • HOME
  • The Podcasts
    • Core Concepts
    • Critical Care Topics
    • Intern Nuggets
    • Pediatric EM
    • Toxicology
    • Trauma Topics
    • Sports Medicine Corner
  • Cards for EM
    • ECG Monthly Lesson
  • CMC Imaging Mastery Project
    • Adult Chest X-Ray Cases
    • Pediatric X-Ray Cases
    • Pediatric Orthopedic X-Ray Cases
    • Abdominal Imaging Room
    • Implanted Device Radiology Room
    • Condition Specific Radiology
  • Global EM
  • Shownotes
    • Core Concepts ShowNotes
    • Cards for EM ShowNotes
    • Ped EM Morsels ReBaked Shownotes
    • Pediatric EM Shownotes
    • Sports Med Shownotes
    • Toxicology Shownotes
    • Trauma Talks Shownotes
  • Subscribe
    • iTunes
    • Google Play
    • Stitcher
  • About
  • Associated Sites
    • CMCEdMasters
    • CMCECGMasters
    • PedEMMorsels
  • HOME
  • The Podcasts
    • Core Concepts
    • Critical Care Topics
    • Intern Nuggets
    • Pediatric EM
    • Toxicology
    • Trauma Topics
    • Sports Medicine Corner
  • Cards for EM
    • ECG Monthly Lesson
  • CMC Imaging Mastery Project
    • Adult Chest X-Ray Cases
    • Pediatric X-Ray Cases
    • Pediatric Orthopedic X-Ray Cases
    • Abdominal Imaging Room
    • Implanted Device Radiology Room
    • Condition Specific Radiology
  • Global EM
  • Shownotes
    • Core Concepts ShowNotes
    • Cards for EM ShowNotes
    • Ped EM Morsels ReBaked Shownotes
    • Pediatric EM Shownotes
    • Sports Med Shownotes
    • Toxicology Shownotes
    • Trauma Talks Shownotes
  • Subscribe
    • iTunes
    • Google Play
    • Stitcher
  • About
  • Associated Sites
    • CMCEdMasters
    • CMCECGMasters
    • PedEMMorsels
Search by typing & pressing enter

YOUR CART

9/9/2020 0 Comments

Bradycardia Basics


  • Quick Differential: DIMES
    • D – drugs (digoxin, CCB, beta blockers, cholinergic drugs, TCAs, Clonidine)
    • I – ischemia (heart and brain)/ infection (sepsis, Lyme disease) 
    • M – metabolic (hypothyroid, hypoglycemia, hypothermia) 
    • E – electrolytes (hyperkalemia, hypokalemia, hypercalcemia, hypocalcemia, hypermagnesemia) 
    • S – sinus dysfunction (SSS, AV block) 
  • Meds: 
    • 3g calcium gluconate (treats hyperK & increases inotropy) 
    • Atropine ? 
      • 0.5 – 1 mg q5min, max dose 3 mg 
      • peds = 0.02 mg/kg
      • Only effective in 28% of patients with symptomatic bradycardia 
      • Atropine shuts down the vagus nerve to remove parasympathetic stimulation to the heart….not effective for many types of bradycardia 
      • Atropine will NOT work in someone who has had a heart transplant, dat vagus nerve has already been cut. 
    • Epinephrine bolus 
      • 20-40 mcg IV (EMCRIT recommended dose using push dose epi) 
      • peds 0.01 mcg/kg in 1:10,000 concentration (code dose concentration) 
      • Epi acts on myocardia muscles, the SA node, and the AV node -> effective against a wider range of underlying pathologies and can help out your BP 
    • Epinephrine drip 2-10 mcg/min 
    • Dopamine drip 2-10 mcg/kg/min 
    • Isoproterenol is a pure beta agonist that can go through a peripheral line 
      • Last ditch med: isoproterenol reported to work really well but $$$$
      • Can also be used in refractory Torsades to shorten QTc (Thanks Dr. Littmann)
    • CONFIRM PACING BY PALPATING A PULSE (or using pulse ox pulse rate NOT rhythm strip on monitor) 
  • Overdoses to consider:
    • Beta blocker OD: glucagon and high dose insulin + dextrose 
    • CCB overdose: high dose insulin + dextrose
      • CCB OD -> hyperglycemia
      • Consider in patients who are not known to be diabetic but present with lab values consistent with DKA + bradycardia + hypotension 
      • The level of hypoglycemia can serve as a marker of severity of shock 
    • Digoxin OD: Digibind
      • Potassium level correlates with level of toxicity 
      • 20 viiles for a coding patient! 
      • Dosing formula on MedCalc using serum level & amount ingested  (mg ingested x 0.8 x 2) 
  • Pacing:
    • Transcutaneous Pacing:
      • https://www.youtube.com/watch?v=1fjmyog37Fo – Peds example, smoooooth voice
      • https://www.youtube.com/watch?v=5qfIRPxoHuw – adult example 
      • https://www.youtube.com/watch?v=UInoEPPjwKo – how to set up the box 
    • Transvenous Pacing:
      • https://www.youtube.com/watch?v=OMtuaBV8C2k – Set up
      • https://www.youtube.com/watch?v=00-T8PcbStE – Procedure
      • https://www.youtube.com/watch?v=9dgZfX7OK_k – trouble shooting
0 Comments

Your comment will be posted after it is approved.


Leave a Reply.

    Archives

    November 2020
    September 2020
    February 2020
    January 2020
    August 2019
    July 2019
    May 2019
    March 2019
    February 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    May 2018
    April 2018
    March 2018
    February 2018

    Categories

    All Core Concepts Pediatric

    RSS Feed

EMGuideWire

Picture
From the J. Lee Garvey Innovation Studio in the 
Department of Emergency Medicine
Carolinas Medical Center
Charlotte, NC

Picture
© COPYRIGHT 2015. ALL RIGHTS RESERVED.
LEGAL DISCLAIMER (to make sure that we are all clear about this):The information on this website and podcasts are the opinions of the authors solely.

For Health Care Practitioners: This website and its associated products are provided only for medical education purposes. Although the editors have made every effort to provide the most up-to-date evidence-based medical information, this writing should not necessarily be considered the standard of care and may not reflect individual practices in other geographic locations.

​For the Public
: This website and its associated products are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Your physician or other qualified health care provider should be contacted with any questions you may have regarding a medical condition. Do not disregard professional medical advice or delay seeking it based on information from this writing. Relying on information provided in this website and podcast is done at your own risk. In the event of a medical emergency, contact your physician or call 9-1-1 immediately.