Not all bradycardias were created equal - Winny Li


image by: Fikri El Tahir Abdalla

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Managing unstable bradycardia

Key step 1: Temporarily increase the heart rate

This can be done either pharmacologically (using dopamine or epinephrine) or electrically (starting with transcutaneous pacing). In the past, I was confused about the order in which these interventions should be tried. My approach now is simple: start both at the same time. Transcutaneous pacing frequently fails and is not a long term solution, so starting a chronotropic medication right away makes sense. However, it takes time to get a drip started and titrated to effect, so an early attempt at transcutaneous pacing is important. Arranging the team so that both of these interventions are implemented in parallel rather than in series…

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 Managing unstable bradycardia

In bradycardic patients, immediate and effective management of airway and breathing is essential, because hypoxia is a potential cause of bradycardia.1,2 However, airway management in the setting of cardiogenic shock is fraught with difficulty.

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