Bradycardia - Acute Managment

• First question you should ask when you hear a low heart rate (or high heart rate) --> what are the rest of his vitals, esp blood pressure?  Need to determine ASAP if pt is hemodynamically stable.  Related, need to find out if pt is symptomatic
• Follow ACLS algorithm - transcutaneous pacer pads on the patient (ready to be turned out if needed), atropine at bedside (doses 0.5 mg IV q5 minutes, up to 3 mg total), and keep in mind epinephrine or dopamine drips, and cards consult for possible transvenous pacing if needed.
• Look for reversible causes of sinus bradycardia - namely, medications (esp beta-blockers, calcium channel blockers, amiodarone, digoxin, but also drugs like lithium), also increased vagal activity, acute MI (i.e. RCA territory), hypothyroidism, hypothermia, increased intracranial pressure.

(Chanu Rhee MD, 8/26/10)