Round 19 (Bradycardia)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!



Case Introduction



You are working a shift at EM Clerkshift General when you are called to the resuscitation bay to see an elderly patient with unstable vitals brought in by EMS.



Initial Vitals



* Temp 98.0F* HR 43* RR 18* BP 60/40* O2 98%



Critical Actions



* Diagnose the etiology for the bradycardia (BB overdose)* Administer Atropine* Administer Glucagon* Administer Epinephrine drip* Attempt transcutaneous/transvenous pacing* Administer high-dose Insulin therapy



Final Diagnosis



Beta Blocker Overdose



Tips and Tricks



* Keep in mind the broad differential for severe bradycardia – ischemia, ingestion, electrolyte abnormalities, intrinsic arrhythmia/heart block, hypothyroidism, hypothermia, hypoglycemia, hypoxia, increased intracranial pressure, neurogenic shock.



Further Reading



High Dose Insulin Therapy (EMCRIT)



Low and Slow Poisoning (EMCASES)