by John Marshall, MD
– Bradycardia (HR <60) can be caused by SA & AV nodal disease
In patients with symptoms of instability (chest pain, AMS, hypotension)… remember: ABC’s, IV, O2, monitor.
- 1st.) Atropine 0.5mg q3-5 min, for a maximum of 3mg (can cause paradoxical bradycardia)
- 2nd.) TransCutaneous pacing, or… Pressors (Epinephrine & Dopamine: Beta 1 activity increases AV node flow and SA conductivity)
- 3rd.) TransVenous pacing + expert consultation
Mobitz type 2 or greater are dispo’ed to CCU (AV blocks may deteriorate into complete block).
Only people to send home are people without comorbidity and received no urgent intervention
- – identifying a block, but missing inferior MI
- – not having pacer pads ready while giving atropine
- – sending someone home that appears better
- – atropine may worsen ischemia in someone with ischemic disease
- – atropine may not work in infra-nodal blocks