ICU Advantage: Bradycardia Algorithm

Introduction

• Presenter: Eddie Watson
• Goal: Simplify complex critical care subjects, focusing on ICU success
• Video Topic: American Heart Association (AHA) ACLS Algorithms - Bradycardia Algorithm

Key Focus

• Bradycardia with Pulse
• Excludes: Brady rhythm without a pulse (Cardiac Arrest Algorithm)

Bradycardia Overview

• Definition: Heart rhythm < 60 BPM
• Concern: Symptomatic bradycardic patients (HR < 50 BPM)
• Symptoms: Slow rhythm with symptoms affecting perfusion

Assessing Necessity

• Determine if Patient is Bradycardic:
  • HR typically < 50 BPM
  • Check for associated symptoms
• Common Rhythms for Symptomatic Bradycardia:
  • Sinus bradycardia
  • First, second (Mobitz I & II), and third degree AV blocks
  • Junctional and ventricular rhythms

Algorithm Steps

1. Assess Underlying Cause:

   • Ensure airway patency, assess breathing
   • Provide O2 if hypoxic
   • Monitor ECG, BP, and O2 saturation
   • Ensure IV access
   • Obtain 12 lead ECG if possible (don't delay treatment)

2. Assess Patient's Stability:

   • Signs of instability:
     • Hypotension (MAP < 60, SBP < 90)
     • Altered level of consciousness
     • Shock symptoms (cool, clammy, pale, cyanosis, rapid breathing)
     • Ischemic chest discomfort
     • Acute heart failure

3. Intervention Steps if Unstable:

   • Administer Atropine:

     • Dose: 1 mg IV push (repeat every 3-5 mins, max 3 mg)
     • Effective for SA and AV nodes (not for complete heart block)
     • Risky in acute MI (increases HR and myocardial workload)

   • If Atropine Ineffective/Not Indicated:

     • Transcutaneous Pacing:
       • Pads on chest, stimulate heart contraction
       • Preferred in acute MI
       • Provide analgesic/sedation as necessary
     • Chemical Pacing:
       • Dopamine: 5-20 mcg/kg/min (titrate to response)
       • Epinephrine: 2-10 mcg/min (titrate to response)

4. Consider Expert Consultation:

   • Persistent bradycardia needing continuous treatment
   • Possible need for transvenous pacing or cath lab

Important Notes

• Comfort with Pacing Equipment:
  • Practice using defibrillator for pacing
• Algorithm Simplicity:
  • Focus on decreased perfusion indicators
  • Prioritize swift action in unstable patients

Conclusion

• Objective: Solidify understanding of the bradycardia algorithm
• Encouragement: Act quickly, share knowledge, engage with community (comments, likes, subscription)
• Support: Memberships and Patreon for further channel development

Additional Resources

• ECG rhythm interpretation series
• Lesson on epinephrine usage in critical care
• Upcoming lessons in AHA ACLS series

---

Thank you for watching and for your support. Stay tuned for the next lesson!