1. List the EKG rhythms for bradycardia?
    • - Sinus bradycardia (40-60 bpm)
    • - First-degree AV block
    • - Second-degree AV block
    • - Type I (Wenkebach/Mobitz I)
    • - Type II (Mobitz II)
    • -Third degree AV block
  2. What is atropine sulfate?
  3. List the indications for atropine sulfate.
    - First drug for symptomatic sinus bradycardia.

    - My be beneficial in presence of AV nodal block or ventricular asystole. Will not be effective for infranodal (Mobitz type II) block.

    - Second drug (after epinephrine or vasopressin) for asystole or bradycardic pulseless electrical activity.

    - Organophosphate (eg, nerve agent) poisoning: extremely large doses may be needed.
  4. What is symptomatic bradycardia?
    • 1. The heart rate is slow.
    • 2. The patient has symptoms.
    • 3. The symptoms are due to the slow heart rate.
  5. What is a bradyarrhythmia or bradycardia?
    It is any rhythm disorder with a heart rate less than 60 beats per minute (bpm)

    Examples include sinus bradycardia and third degree AV block.

    The terms, bradyarrhythmia and bradycardia, are used interchangeably. Bradycardia is used more commonly.
  6. What are the signs or symptoms of poor perfusion caused by a bradycardia?
    • - acute altered mental status
    • - ongoing chest pain
    • - hypotension
    • - other signs of shock
  7. Is it possible to have symptoms of low heart rate when the rate is 68?

    Some medical conditions a patient necessitate a higher than normal heart rate in order for the oxygenation needs of the body to be met. If, during this time, the heart rate is too slow, the patient has a functional or relative bradycardia.

    For example, a HR of 70 will probably be too slow for a patient in septic shock or cardiogenic shock.
  8. Why should atropine be used with caution in the presence of myocardial ischemia and hypoxia?
    It increases myocardial oxygen demand.
  9. Should atropine be given for hypothermic bradycardia?
  10. How should atropine be administered for Asystole or Pulseless Electrical Activity (PEA)?
    - 1 mg IV/IO push

    - May repeat every 3-5 min (if asystole persists) to a maximum of 3 doses (3 mg)
  11. How should atropine be administered for Bradycardia?
    - 0.5 mg IV every 3-5 minutes, as needed, not to exceed total dose of 0.04 mg/kg (total 3 mg)

    - Use shorter dosing interval (3 minutes and higher doses in severe clinical conditions.
  12. How should atropine be used in the presence of Acute Coronary Syndrome (ACS)?
  13. How should atropine sulfate be administered via the endotracheal tube?
    2-3 mg diluted in 10 ml water or normal saline
  14. What may result from doses of atropine sulfate that are less than 0.5 mg?
    A paradoxical slowing of the heart rate.
  15. Mrs. Jones has had a recent inferior wall MI. She denies pain or discomfort.
    She is alert and oriented x3, normal heart sounds, lungs are clear, skin is warm, mucous membranes and nail beds are pink, good urine output and appears to be resting comfortably. VS: 96/60 - 49 (sinus bradycardia with first degree AV-block) - 16 and O2 saturation is 92%.

    What should you do next?
    - Continue to monitor.

    - No treatment is indicated.
Card Set
Adapted from ACLS Core Drugs - 2006 American Heart Association