ED Weekly Simulation
22 September 2016 — Adults
Topic
Symptomatic Bradycardia
Scenario
R40 notifying incoming 66 year old male with HR 35bpm; BP 80/40; GCS 15
Location
Resus One
Time of Presentation
Day shift
Preparation of the room prior to pt arrival
What is Symptomatic Bradycardia
1. Consider the details given via the R40. For this patient he is
symptomatic therefore think ahead to what you are likely to
need i.e. adrenalin, atropine, dopamine, fluids, defib/pacing
2. Assemble team, allocate roles— hand yellow jacket to team
leader (& advise clerical team)
3. Scribe R40 details on to white board
4. Assemble monitoring equipment ready for immediate attachment
5. Don appropriate PPE
Symptomatic bradycardia is defined as a heart rate less
than 60/min that elicits signs and symptoms but the
heart rate will usually be less than 50/min. Symptomatic
bradycardia exists when the following 3 criteria are present:
1) The heart rate is slow
2) The patient has symptoms
3) The symptoms are due to the slow heart rate
Look for reversible causes (H & T’s)
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Hypoxia
Hypovolaemia
Hyper/Hypokalaemia/metabolic disorder
Hypothermia/hyperthermia
Tension pneumothorax
Tamponade
Toxins
Isoprenaline
Chemical tx
is often
better than
Mechanical
tx
What is this? Isoprenaline is a Sympathomimetic/Beta-Adrenoceptor Agonist —
Inotrope i.e. it acts on the heart, bronchi,
skeletal muscle, alimentary tract and is used mainly as a
bronchodilator and heart stimulant.
How to I administer it? Isoprenaline is administered via an infusion, see the quick reference card as
below or refer to the ED Resus Flipcard and/or NOIDs
What do I need to monitor the patient for?
Pacing on the Zoll defibs
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Provide comfort to pt first (sedatation/analgesia)
Set Pacing in demand mode
Dial up the rate (usually 60-70 bpm)
Dial up current (mA) start from minimum output—
increase current until capture (you’ll see a pacing spike)
- CHECK you have mechanical capture i.e. via palpable pulse with each
QRS complex
 Continue pacing at an output level just above threshold of initial capture
 Check patient comfort & continue monitoring of patient
 Monitor for signs and symptoms of hypersensitivity/
anaphylaxis (the sulphite-containing formula may
precipitate allergic reactions in susceptible people)
 Monitor vital signs: heart rate, blood pressure, respiratory rate & ECG
 Continuous cardiac monitoring recommended during IV infusions, including central venous pressure
and blood gases
 Monitor urinary output and electrolytes
(NOIDs)
See your Nurse Educators & Clinical Coaches for a 1:1 session
Refer to the guideline below for additional information
Use of External Pacer
Adult Bradycardia algorithm
Transfer of Patient out of ED
Next week will be another exciting learning opportunity in adult resus, let
us know if you are keen to participate in a sim to refresh and/or expand
your knowledge & skill