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Cardiac/Bradycardia: Clinical Practice Guidelines

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108 views3 pages

Cardiac/Bradycardia: Clinical Practice Guidelines

protap ambulance

Uploaded by

teguh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Clinical Practice Guidelines:

Cardiac/Bradycardia
Version February 2015
Disclaimer and copyright
2015 Queensland Government
All rights reserved. Without limiting the reservation of copyright, no person shall reproduce,
store in a retrieval system or transmit in any form, or by any means, part or the whole of the
Queensland Ambulance Service (QAS) Clinical practice manual (CPM) without the prior
written permission of the Commissioner.
The QAS accepts no responsibility for any modification, redistribution or use of the CPM
or any part thereof. The CPM is expressly intended for use by QAS paramedics when
performing duties and delivering ambulance services for, and on behalf of, the QAS.
Under no circumstances will the QAS, its employees or agents, be liable for any loss, injury,
claim, liability or damages of any kind resulting from the unauthorised use of, or reliance
upon the CPM or its contents.
While effort has been made to contact all copyright owners this has not always been possible.
The QAS would welcome notification from any copyright holder who has been omitted or
incorrectly acknowledged.
All feedback and suggestions are welcome, please forward to:
[email protected]

This work is licensed under the Creative Commons


Attribution-NonCommercial-NoDerivatives 4.0
International License. To view a copy of this license,
visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Bradycardia
February, 2015

Bradycardia is defined as a heart rate of < 60 bpm in adults and


is age dependant in children. However, bradycardia may be
considered normal for some patients (e.g. whilst at rest or very
fit individuals). Patients with asymptomatic bradycardia rarely
require treatment.

Clinical features

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Hypotension (< 90 mmHg systolic)
Syncope
ALOC

Bradycardia can be classified as cardiac or non-cardiac.

Chest pain and/or discomfort (described


as burning, pressure or tightness)

Cardiac: associated with a diseased SA node, AV node or

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His-Purkinje system.

Congestive cardiac failure

Non-cardiac: associated with environmental conditions,

Dyspnoea

metabolic or endocrine disorders and toxicology.

Diaphoresis

Common types of bradycardic rhythms include:

Nausea and/or vomiting


Dizziness

sinus bradycardia

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sick sinus syndrome

Risk Assessment

high degree AV block:

- AV nodal (junctional) escape

Hypoxia is a common cause of bradycardia


and initial management should focus on
improving oxygenation and ventilation.

- ventricular escape (usually occurs with 3rd degree AV block) [1,2]

The treatment of non-cardiac bradycardia


should always commence with focusing
on removing and/or reversing any
causative factors.

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e

Additional information

Treatment should be aimed at restoring cardiac output


and cerebral perfusion, whilst targeting a heart rate
appropriate for the age of the patient.

Figur
e 2.6

QUEENSLAND AMBULANCE SERVICE

53

CPG:Paramedic
Paramedicsafety
Safety
CPG:
CPG:Standard
Standardcares
Cares
CPG:

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Acute symptomatic
bradycardia?

Transport to hospital

Pre-notify as appropriate

Manage as per appropriate CPG:

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Resuscitation required?

CPG: Resuscitation Adult

CPG: Resuscitation Paediatric

CPG: Resuscitation Newly born

Consider:

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Reversible causes
Atropine

Transcutaneous pacing
Adrenaline
Isoprenaline

Note: Officers are only to perform


procedures for which they have
received specific training and
authorisation by the QAS.

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Transport to hospital

Pre-notify as appropriate

54

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