Supraventricular Bradycardia and AV Blocks: Difference between revisions

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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) - [[Medical Gases|OXYGEN]] @ 100% via NRB mask or assist with BVM.  
[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[Oxygen|OXYGEN]] @ 100% via NRB mask or assist with BVM.
 
'''STABLE:'''
* For 2nd Degree, Type II or 3rd Degree Heart Block, Apply [[Transcutaneous Pacing Procedure|transcutaneous pacemaker]] (TCP) on stand-by mode.


'''UNSTABLE:'''  
'''UNSTABLE:'''  
*Apply [[Transcutaneous Pacing Procedure|TCP]] on stand-by.
* [[Atropine|ATROPINE SULFATE]] 1.0 mg rapid IVP
* [[Antiarrhythmics|ATROPINE SULFATE]] 0.5 - 1.0 mg rapid IVP
* 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.
* If transient increase in heart rate noted and improved patient status, Repeat [[Antiarrhythmics|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 [[Sedative Hypnotics|VERSED]] 2-5 mg initial dose then 2 mg every 30 seconds to 1 minute for conscious sedation.
* 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.
* [[Adrenergics|DOPAMINE]] 5 - 20 mcg / kg / minute titrated to systolic BP > 90 mm Hg.
* [[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 [[Antiarrhythmics|ATROPINE SULFATE]] and proceed directly to pacing.
* If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, consider pacing before giving [[Atropine|ATROPINE SULFATE]].  If the patient already has an IV/IO and [[Atropine|ATROPINE SULFATE]] is ready administer the ATROPINE.
* 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 [[Antidiabetics|GLUCAGON]] 2mg (may repeat x 1)
** For calcium channel and beta blockers, administer [[Glucagon|GLUCAGON]] 2mg (may repeat x 1)
** For calcium channel blockers, administer [[Electrolytes|CALCIUM CHLORIDE]] 1 gram IVP.  (Avoid if patient in on digoxin or lanoxin).
** 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 [[Electrolytes|SODIUM BICARBONATE]], 1 mEq/kg IVP.
** 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 [[Antagonists|NALOXONE (NARCAN)]] 0.4 mg IVP, IO or IN start low and titrate for respiratory function improvement. Maximum total dose of 2 mg.
** 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 [[Antiarrhythmics|LIDOCAINE]] TO THESE RHYTHMS'''''
'''''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 14:26, 8 April 2024

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.

UNSTABLE:

  • ATROPINE SULFATE 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, consider pacing before giving ATROPINE SULFATE. If the patient already has an IV/IO and ATROPINE SULFATE is ready administer the ATROPINE.
  • 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.

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