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)