Difference between revisions of "Supraventricular Bradycardia and AV Blocks"
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===4.06 SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS=== | ===4.06 SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS=== | ||
| − | [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[ | + | [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[Oxygen|OXYGEN]] @ 100% via NRB mask or assist with BVM. |
'''STABLE:''' | '''STABLE:''' | ||
| Line 9: | Line 9: | ||
'''UNSTABLE:''' | '''UNSTABLE:''' | ||
*Apply [[Transcutaneous Pacing Procedure|TCP]] on stand-by. | *Apply [[Transcutaneous Pacing Procedure|TCP]] on stand-by. | ||
| − | * [[ | + | * [[Atropine|ATROPINE SULFATE]] 0.5 - 1.0 mg rapid IVP |
| − | * If transient increase in heart rate noted and improved patient status, Repeat [[ | + | * If transient increase in heart rate noted and improved patient status, Repeat [[Atropine|ATROPINE SULFATE]] as needed every 3 minutes to a total dose of 3.0 mg. |
* Initiate [[Transcutaneous Pacing Procedure|TCP]]. Pacemaker output may cause excessive pain / distress in the conscious patient. | * Initiate [[Transcutaneous Pacing Procedure|TCP]]. Pacemaker output may cause excessive pain / distress in the conscious patient. | ||
| − | * Consider administration of [[ | + | * Consider administration of [[Versed|VERSED]] 2-5 mg initial dose then 2 mg every 30 seconds to 1 minute for conscious sedation. |
* If mechanical capture present and symptoms unresolved, increase TCP by 10 BPM until improvement noted or TCP set at 80 BPM. | * If mechanical capture present and symptoms unresolved, increase TCP by 10 BPM until improvement noted or TCP set at 80 BPM. | ||
* 0.9% NaCl 200 - 300 ml fluid bolus. | * 0.9% NaCl 200 - 300 ml fluid bolus. | ||
| − | * [[ | + | * [[Dopamine|DOPAMINE]] 5 - 20 mcg / kg / minute titrated to systolic BP > 90 mm Hg. |
| − | * If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, bypass [[ | + | * If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, bypass [[Atropine|ATROPINE SULFATE]] and proceed directly to pacing. |
* If drug induced, treat as per specific drug overdose. | * If drug induced, treat as per specific drug overdose. | ||
| − | ** For calcium channel and beta blockers, administer [[ | + | ** For calcium channel and beta blockers, administer [[Glucagon|GLUCAGON]] 2mg (may repeat x 1) |
| − | ** For calcium channel blockers, administer [[ | + | ** For calcium channel blockers, administer [[Calcium Chloride|CALCIUM CHLORIDE]] 1 gram IVP. (Avoid if patient in on digoxin or lanoxin). |
| − | ** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[ | + | ** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[Sodium Bicarbonate|SODIUM BICARBONATE]], 1 mEq/kg IVP. |
| − | ** For narcotic OD, administer [[ | + | ** For narcotic OD, administer [[Naloxone|NALOXONE (NARCAN)]] 0.4 mg IVP, IO or IN start low and titrate for respiratory function improvement. Maximum total dose of 2 mg. |
| − | '''''DO NOT GIVE [[ | + | '''''DO NOT GIVE [[Lidocaine|LIDOCAINE]] TO THESE RHYTHMS''''' |
This Standing Order is divided between the care and treatment of the stable patient verses the unstable patient. As a matter of definition agreed upon by the Medical Directors, the UNSTABLE patient is one who presents with any of the following: '''''SIGNIFICANT CARDIAC, SUSPECTED CARDIAC, SIGNIFICANT DYSPNEA, ALTERED MENTAL STATUS, OR HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION, OR SIGNIFICANT COMPROMISE OF AIRWAY, BREATHING, AND/OR CIRCULATION.''''' | This Standing Order is divided between the care and treatment of the stable patient verses the unstable patient. As a matter of definition agreed upon by the Medical Directors, the UNSTABLE patient is one who presents with any of the following: '''''SIGNIFICANT CARDIAC, SUSPECTED CARDIAC, SIGNIFICANT DYSPNEA, ALTERED MENTAL STATUS, OR HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION, OR SIGNIFICANT COMPROMISE OF AIRWAY, BREATHING, AND/OR CIRCULATION.''''' | ||
[[Category:Cardiac|0406]] | [[Category:Cardiac|0406]] | ||
Latest revision as of 05:39, 13 November 2020
Section 4 - CARDIAC
4.06 SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS
INITIAL MEDICAL CARE (2.01) - OXYGEN @ 100% via NRB mask or assist with BVM.
STABLE:
- For 2nd Degree, Type II or 3rd Degree Heart Block, Apply transcutaneous pacemaker (TCP) on stand-by mode.
UNSTABLE:
- Apply TCP on stand-by.
- ATROPINE SULFATE 0.5 - 1.0 mg rapid IVP
- If transient increase in heart rate noted and improved patient status, Repeat ATROPINE SULFATE as needed every 3 minutes to a total dose of 3.0 mg.
- Initiate TCP. Pacemaker output may cause excessive pain / distress in the conscious patient.
- Consider administration of VERSED 2-5 mg initial dose then 2 mg every 30 seconds to 1 minute for conscious sedation.
- If mechanical capture present and symptoms unresolved, increase TCP by 10 BPM until improvement noted or TCP set at 80 BPM.
- 0.9% NaCl 200 - 300 ml fluid bolus.
- DOPAMINE 5 - 20 mcg / kg / minute titrated to systolic BP > 90 mm Hg.
- If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, bypass ATROPINE SULFATE and proceed directly to pacing.
- If drug induced, treat as per specific drug overdose.
- For calcium channel and beta blockers, administer GLUCAGON 2mg (may repeat x 1)
- For calcium channel blockers, administer CALCIUM CHLORIDE 1 gram IVP. (Avoid if patient in on digoxin or lanoxin).
- For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer SODIUM BICARBONATE, 1 mEq/kg IVP.
- For narcotic OD, administer NALOXONE (NARCAN) 0.4 mg IVP, IO or IN start low and titrate for respiratory function improvement. Maximum total dose of 2 mg.
DO NOT GIVE LIDOCAINE TO THESE RHYTHMS
This Standing Order is divided between the care and treatment of the stable patient verses the unstable patient. As a matter of definition agreed upon by the Medical Directors, the UNSTABLE patient is one who presents with any of the following: SIGNIFICANT CARDIAC, SUSPECTED CARDIAC, SIGNIFICANT DYSPNEA, ALTERED MENTAL STATUS, OR HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION, OR SIGNIFICANT COMPROMISE OF AIRWAY, BREATHING, AND/OR CIRCULATION.
