Sinus Bradycardia management? - longislandmd2b

[ArchivalUser]

Sinus Bradycardia (HR < 60) is managed by the following:
Stable-->Atropine-->Does not work-->Pacing
Unstable-->Epinepherine
Chronic-->Pacing

Does this look about right to you guys? Or is an unstable patient also managed via Atropine?

[ArchivalUser]

this is an interesting question. I think we use atropine even in ustable patient such as hypotension, syncope. If no response we use pacemaker. epinephrine is used in case of cardiac arrest.

[ArchivalUser]

This makes sense, as there does not seem to be a point to oppose vagal tone via Atropine if the heart is in Arrest. Where as in an unstable patient with Bradycardia he is not in Arrest he just has a really slow HR.

Thanks for helping me think this one out! I agree with yoour logic.

[ArchivalUser]

when the pt is unstable (hypotension) give epi/dopamine along with atropine to improve blood pressure...consider pacing in next step...

[ArchivalUser]

stable-->observe
unstable--> atropine while awaiting pacer-->SQ pacing first then prepare for IV pacing
epinephrine/dopamine can use instead of atropine or if pacing is not effective

[ArchivalUser]

Anyone think the answer is DDDD here? HTN Urgency with no evidence of end organ damage (papiledema, encephalopathy, nephropathy) is treated with ORAL BP meds right. While evidence of Urgency + end organ damage = IV Nitroprusside or IV Labetalol

[ArchivalUser]

ugh, oops posted that last one in the wrong thread....lol