Cardiovascular Critical Care I

N

Assess appropriateness for clinical condition

Heart rate typically < 50 bpm if bradyarrhythmia

Identify and treat underlying cause

•

Maintain patent airway; assist breathing as necessary

•

If patient is short of breath, administer oxygen

•

Oxygen as indicated

•

Cardiac monitor to identify rhythm; monitor blood pressure and oximetry

•

IV access

•

12-lead ECG if available, don’t delay therapy

Persistent bradyarrhythmia causing:

•

Hypotension?

•

Acutely altered mental status?

•

Signs of shock?

•

Ischemic chest discomfort?

•

Acute heart failure?

Atropine IV Dose:

First dose: 1 mg

Repeat every 3-5 minutes

Max: 3 mg

If atropine ineffective:

•

Transcutaneous pacing

OR

•

Dopamine IV infusion: 5-20 mcg/kg/min

OR

•

Epinephrine IV infusion: 2-10 mcg/min

Consider:

•

Expert consultation

•

Transvenous pacing

Monitor and

observe

N

Y

Heart Association guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular

Care (Circulation 2021;142(14_suppl_2):S366-468).