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Symptomatic Bradycardia Oshkosh Fire Dept

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					  Symptomatic Bradycardia                                            Oshkosh Fire Dept
                                             Routine Medical Assessment


                   Oxygen
                   • 2 lpm via nasal cannula
                   • Titrate to maintain an oxygen saturation of greater than or equal to 94%

          NOTE: If 12 Lead                                Monitor
         reveals an acute MI,                             -12 Lead
           Contact medical
            Control before
           increasing Heart                        Normal Saline
                 Rate                              • TKO


                                Yes                   Symptomatic?                    No

         Narrow           QRS Width                  Wide
                                                                                                     Observe

Atropine                                                             No
                                                   Pulse?
• 0.5 mg IVP                                                                     To PEA Protocol
• Repeat to a total of 3 doses for
   refractory narrow complex                        Yes
   bradycardias

                                             External Pacing
                                             • Anterior/posterior                 Note?
External pacing                                 electrode placement               Signs of symptomatic Bradycardia:
• If patient remains symptomatic.               preferred.                        Altered mental status
• Consider for refractory narrow             • Set heart rate for 70              Chest pain
   complex bradycardias.                        beats per min.                    Marked dyspnea
                                             • Starting at 40                     Nausea
                                                                                  Dizziness
                                                milliamps, increase               Diaphoresis
                                                amperage by 20 mA                 PVCs
 Dopamine                                       every 15 sec., until              BP<90 mmHg
 • Contact Medical Control                      100% capture is
                                                achieved, then decrease
                                                amperage by 5 mA to
                                                lowest level that
                                                maintains capture/pulse.


                                      Steve Stroman, MD, FACEP, FAAEM, EMT-P
                                           Medical Director, Oshkosh Fire Dept

  B-4                                                                                                     03/15/08

				
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