Bradycardia & Tachycardia tx

Most recent AHA algorithms here

Assess
- Airway/breathing
- Rhythm/blood-pressure/saturation
- IV access
- 12-lead (don't delay tx to obtain)
Sick or not sick?
- Hypotension
- Diaphoretic/pale
- HF SSX, chest pain
- New AMS

Give 1 mg atropine
- Can give a total of 3 doses (3mg) spaced every 3-5 mins
- Atropine doesn't work in:
  - 2nd ° type II (wide) or 3rd ° (complete) block
Or transcutaneous pacing (pads)
- 2nd ° type II (wide) or 3rd ° (complete) block
Or Epinephrine
- 2-10 µg/kg/min titrated to response
Or Dopamine
- 5-20 µg/kg/min titrated to response

Narrow QRS
- Regular?
  - Try vagal maneuvers
  - Then 6mg adenosine IV push (AC); double the dose to 12mg if it doesn't break
  - β-blockers or CCB
- Irregular?
  - Diltiazem (Cardizem) 15mg over 2 mins
  - >48hrs ➔ anticoagulation before converting with electricity
Wide QRS
- 150 mg amiodarone infused over 10 minutes, (maintain 1mg/min for 6hrs); can repeat loading dose if it doesn't break
- or 20-50mg/min procainamide infused til QRS ↓ by half or max dose (17mg/kg)
  - Avoid in prolonged QT or CHF
- Sotalol 100mg or 1.5mg/kg over 5 minutes
  - Avoid in prolonged QT
ANY CHANCE THE ARRHYTHMIA IS ASSOCIATED WITH WPW:
- 20-50mg/min procainamide infused til QRS ↓ by half or max dose (17mg/kg)