2-6 BRADYCARDIA (SYMPTOMATIC)

Symptomatic dysrhythmia may be indicated by: acute altered mental status, ongoing severe ischemic chest pain, congestive heart failure, hypotension, or other signs of shock that persist despite adequate airway and breathing. Any patient requiring ACLS care should have an ALS intercept if logistically possible.

EMR - Emergency Medical Responder

1. Begin initial medical care
2. Administer oxygen
3. Assist ventilations if RR < 8 or > 35
4. Assess for hypotension/ shock (HR >130, cap refill > 2 seconds) & follow shock protocol
5. Call for ALS intercept

EMT- Emergency Medical Technician  perform/confirm all above interventions

1. Assure ALS intercept is en route
2. Transport as early as possible
3. Measure blood sugar if indicated, follow hypoglycemia protocol
4. For symptomatic bradycardia (HR < 60 with cardio-respiratory compromise)
   1. Place supine, elevate feet
5. Reassess VS often during transport
6. Apply ECG monitor & run strip (if trained, if time allows and after all other interventions are completed)
7. Perform 12-lead ECG (if trained) as indicated

CONTACT MEDICAL CONTROL

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Start IV access en route, NS TKO (do not delay transport) CONTACT MEDICAL CONTROL
2. Administer additional NS fluid bolus, as directed

Intermediate perform/confirm all above interventions

1. Attach cardiac monitor if not already done, confirm rhythm in more than 1 lead
2. For symptomatic bradycardia
   1. Administer atropine 1 mg IV/IO; May repeat 1 mg every 3-5 minutes to max dose of 3 mg
   2. Administer NS fluid bolus 500 mL if lung are clear
3. Initiate available re-warming measures for hypothermia
4. Observation and transport for asymptomatic bradycardia
5. Reassess VS and rhythm frequently

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Paramedic perform/confirm all above interventions

1. If symptomatic bradycardia persists, Initiate an IV vassopressor
   1. Administer epinephrine 2 to 10 mcg/min -OR-
   2. Administer dopamine (Intropin) 5-20 mcg/kg/min, expect to start at 10 mcg/kg/min
2. Pacing may be preferred to medications during ischemia, circumstances when uncontrolled tachycardia may be detrimental and in 2^nd degree type II and 3^rd degree AVB; Prepare to pace if 2^nd degree type II or 3^rd degree AVB
3. Begin transcutaneous pacing if preceding treatment was unsuccessful and the patient is symptomatic
   1. Sedate with versed 2 mg slowly IV/IO if indicated; May repeat to max dose of 4 mg
   2. Start at HR 100 and 50 mA, increasing by 10mA increments until capture with pulse

CONTACT MEDICAL CONTROL