Notes – Bradycardia

Bradycardia

Patient Safety Considerations

  1. Observe for signs of clinical deterioration: dysrhythmias, CP, SOB, decreased LOC/syncope, or other signs of shock/hypotension
  2. Perform serial 12-lead EKGs (especially any time clinical changes noted)

Notes/Educational Pearls

Key Considerations

Acute coronary syndrome may present with atypical pain, vague or only generalized complaints.

Pertinent Assessment Findings

A complete medication list should be obtained from each patient. It is especially important for the treating physician to be informed if the patient is taking beta-blockers, calcium channel blockers, clonidine, digoxin, blood thinners (anticoagulants), and medications for the treatment of erectile dysfunction or pulmonary hypertension.

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914117 – Medical-Cardiac Chest Pain
  • 9914143 – Medical-ST-Elevation Myocardial Infarction (STEMI)

Key Documentation Elements

  • The time of symptom onset
  • The time of patient contact by EMS to the time of 12-lead EKG acquisition
  • The time ASA administered, or reason why not given
  • The time of STEMI notification

Performance Measures

  • The time of patient contact by to the time of 12-lead EKG acquisition within 10 minutes
  • The time from first diagnostic 12-lead EKG to STEMI notification.
  • Confirmation patient received Aspirin (taken Prior To EMS Arrival, given by EMS, or substantiated by other pertinent negatives)
  • The time of a STEMI patient’s ultimate arrival to a receiving hospital
  • *The time of EMS notification to the time of activation of a cardiac catheterization laboratory
  • *The time of arrival at the PCI center to the time of cardiac catheterization (door-to-balloon time) OR if patient not transported directly to PCI center, the time of arrival at receiving hospital to thrombolytics
  • *The time of prehospital 12-lead EKG acquisition to the time of cardiac catheterization (EKG-to-balloon time)
    • *NOTE: These measures can only be evaluated if EMS documentation can be combined with information provided by the receiving hospital

References

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  2. De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362:779-89.
  3. Gottlieb M. Bolus dose of epinephrine for refractory post-arrest hypotension. CJEM. 2017;10:1-5.
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  6. Sherbino J, Verbeek PR, MacDonald RD, Sawadsky BV, McDonald AC, Morrison LJ. Prehospital transcutaneous cardiac pacing for symptomatic bradycardia or bradyasystolic cardiac arrest: a systematic review. Resuscitation. 2006;70(2):193-200.
  7. Weingart S. EMCrit Podcast 6 – Push-Dose Pressors. July 10, 2009. http://emcrit.org/podcasts/bolus-dose-pressors/. Accessed February 1, 2017.
  8. Weingart S. Push-dose pressors for immediate blood pressure control. Clin Exp Emerg Med. 2015;2(2):131-132.