Answer No: If BP is low or signs of poor tissue perfusion like ongoing chest pain, or altered LOC, then go to tx.
Tx:
Consider Atropine 0.5 mg IV q 3-5 minutes to a maximum dose of 3 mg.
Note: Atropine will not work on denervated hearts (heart transplants). Note: Atropine may be considered, but if pt is in 2nd degree type II or 3rd degree block, it may extend the block to 3rd degree or asystole.
Epinephrine drip IV at 2-10mcg/min
Dopamine drip IV at 2-10 mcg/kg/min
Isoproterenol was not recommended last change, but was still an option. With the 2005 change, it is completely eliminated from the algorithm because no evidence showed a benefit to the patient.
Note:
Heart Rate Slow = absolute bradycardia is rate < 60
Relatively Slow = rate less than expected, relative to underlying condition or cause (for example an athelete with a normal low heart rate does not need to be treated and an elderly person with a normal heart rate of 100 may not tolerate one in the 70s - Treat the patient, not the monitor.)
Primary ABCD Survey
*Assess Airway; Open if needed.
*Assess Breathing; Provide oxygen and noninvasive assistance as
needed.
*Assess Circulation; We find that the heart rate is there but slow.
*Assess need for Defibrillation; In this case, defibrillation is not required,
but we do need a monitor and defibrillator available. So we send
someone after a crash cart or activate EMS if out of a hospital situation.
Secondary ABCD Survey
*Assess Airway (invasively secure airway if needed)
*Assess Breathing (assist pt efforts if needed by bagging pt with 100% oxygen)
*Assess Circulation (With above, O2-IV-Monitor)
-Monitor Vital Signs including pulse oximeter and BP
These have been eliminated on the algorithm, but still maybe useful after asking the perfusion question below.
-Obtain and review 12 lead ECG
-Obtain and review portable Chest X-Ray
-Obtain a problem focused history
-Obtain a problem focused physical examination
-Consider causes (Differential Diagnosis-see PEA for Hs and Ts for
some possibilities and treatments)
Signs: decreased blood pressure, shock, pulmonary congestion, heart
failure
Symptoms: chest pain, shortness of air, decreased level of
consciousness
"Does the patient have adequate perfusion related to the slow rate?"
