A slow & steady heart is good unless it makes you unsteady on your feet or pass out – that’s not good ! One needs to determine cause to figure out if bradycardia is temporary & treatable or if this needs a pacemaker.
Stay calm & get a full set of vitals. If passed out or BP is low, lay the patient flat, get atropine doses going, get pacer patches on. Get an EKG. Recall culprits of bradycardia using this excellent mnemonic “BEATING COLD” (a slow-beating heart is a ‘cold’ heart ;-)) to troubleshoot & see what applies to your patient. Note than multiple causes could co-exist and add-on to the bradycardia effect.
B – Bradyarrhythmias or Heart Blocks ? (e.g. Mobitz Type 2)
E – Electrolytes ? (Hyperkalemia, hypercalcemia), Embolism (PE) with heart strain
A – Acidosis
T – Temperature Low ? / Thyroid levels Low ?
I – Inferior wall MI
N – Neural mediation (Vasovagal) ? sec. to pain,cough,etc.
G – Glucose low ? (Hypoglycemia)
C – Cerebral pressure elevation (Cushing’s reflex)
O – Oxygen low ? / OSA (Obstructive Sleep Apnea) ?
L – Lyme disease, Leptospirosis, Legionnaries, etc infections associated with bradycardia
D – Drugs & Intoxications (Beta-blockers, CCBs, Digoxin, Precedex, OPC poisoning, Opiods, etc.)
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