Supraventricular Bradycardia and AV Blocks - Revision history

Treloars: /* 4.06 SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS */

2024-04-08T14:26:27Z

4.06 SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS

← Older revision		Revision as of 14:26, 8 April 2024
Line 5:		Line 5:

	'''UNSTABLE:'''		'''UNSTABLE:'''
	* [[Atropine\|ATROPINE SULFATE]] ~~0.5 -~~ 1.0 mg rapid IVP		* [[Atropine\|ATROPINE SULFATE]] 1.0 mg rapid IVP
	* If transient increase in heart rate noted and improved patient status, Repeat [[Atropine\|ATROPINE SULFATE]] as needed every 3 minutes to a total dose of 3.0 mg.		* If transient increase in heart rate noted and improved patient status, Repeat [[Atropine\|ATROPINE SULFATE]] as needed every 3 minutes to a total dose of 3.0 mg.
	* Initiate [[Transcutaneous Pacing Procedure\|TCP]]. Pacemaker output may cause excessive pain / distress in the conscious patient.		* Initiate [[Transcutaneous Pacing Procedure\|TCP]]. Pacemaker output may cause excessive pain / distress in the conscious patient.
Line 12:		Line 12:
	* 0.9% NaCl 200 - 300 ml fluid bolus.		* 0.9% NaCl 200 - 300 ml fluid bolus.
	* [[Dopamine\|DOPAMINE]] 5 - 20 mcg / kg / minute titrated to systolic BP > 90 mm Hg.		* [[Dopamine\|DOPAMINE]] 5 - 20 mcg / kg / minute titrated to systolic BP > 90 mm Hg.
	* If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, ~~bypass~~ [[Atropine\|ATROPINE SULFATE]] and ~~proceed directly to pacing~~.		* If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, consider pacing before giving [[Atropine\|ATROPINE SULFATE]]. If the patient already has an IV/IO and [[Atropine\|ATROPINE SULFATE]] is ready administer the ATROPINE.
	* If drug induced, treat as per specific drug overdose.		* If drug induced, treat as per specific drug overdose.
	** For calcium channel and beta blockers, administer [[Glucagon\|GLUCAGON]] 2mg (may repeat x 1)		** For calcium channel and beta blockers, administer [[Glucagon\|GLUCAGON]] 2mg (may repeat x 1)

Treloars at 14:37, 9 January 2023

2023-01-09T14:37:32Z

← Older revision		Revision as of 14:37, 9 January 2023
Line 2:		Line 2:
	===4.06 SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS===		===4.06 SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS===

	[[Initial Medical Assessment and Care\|INITIAL MEDICAL CARE]] (2.01) - [[Oxygen\|OXYGEN]] @ 100% via NRB mask or assist with BVM.		[[Initial Medical Assessment and Care\|INITIAL MEDICAL CARE]] (2.01) - [[Oxygen\|OXYGEN]] @ 100% via NRB mask or assist with BVM.

	~~'''STABLE:'''~~
	* For 2nd Degree, Type II or 3rd Degree Heart Block, Apply [[Transcutaneous Pacing Procedure\|transcutaneous pacemaker]] (TCP) on stand-by mode.

	'''UNSTABLE:'''		'''UNSTABLE:'''
	*Apply [[Transcutaneous Pacing Procedure\|TCP]] on stand-by.
	* [[Atropine\|ATROPINE SULFATE]] 0.5 - 1.0 mg rapid IVP		* [[Atropine\|ATROPINE SULFATE]] 0.5 - 1.0 mg rapid IVP
	* If transient increase in heart rate noted and improved patient status, Repeat [[Atropine\|ATROPINE SULFATE]] as needed every 3 minutes to a total dose of 3.0 mg.		* If transient increase in heart rate noted and improved patient status, Repeat [[Atropine\|ATROPINE SULFATE]] as needed every 3 minutes to a total dose of 3.0 mg.

Treloars at 14:32, 24 April 2020

2020-04-24T14:32:05Z

← Older revision		Revision as of 14:32, 24 April 2020
Line 2:		Line 2:
	===4.06 SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS===		===4.06 SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS===

	[[Initial Medical Assessment and Care\|INITIAL MEDICAL CARE]] (2.01) - [[~~Medical Gases~~\|OXYGEN]] @ 100% via NRB mask or assist with BVM.		[[Initial Medical Assessment and Care\|INITIAL MEDICAL CARE]] (2.01) - [[Oxygen\|OXYGEN]] @ 100% via NRB mask or assist with BVM.

	'''STABLE:'''		'''STABLE:'''

Treloars at 14:00, 24 April 2020

2020-04-24T14:00:51Z

← Older revision		Revision as of 14:00, 24 April 2020
Line 12:		Line 12:
	* If transient increase in heart rate noted and improved patient status, Repeat [[Atropine\|ATROPINE SULFATE]] as needed every 3 minutes to a total dose of 3.0 mg.		* If transient increase in heart rate noted and improved patient status, Repeat [[Atropine\|ATROPINE SULFATE]] as needed every 3 minutes to a total dose of 3.0 mg.
	* Initiate [[Transcutaneous Pacing Procedure\|TCP]]. Pacemaker output may cause excessive pain / distress in the conscious patient.		* Initiate [[Transcutaneous Pacing Procedure\|TCP]]. Pacemaker output may cause excessive pain / distress in the conscious patient.
	* Consider administration of [[~~Sedative Hypnotics~~\|VERSED]] 2-5 mg initial dose then 2 mg every 30 seconds to 1 minute for conscious sedation.		* Consider administration of [[Versed\|VERSED]] 2-5 mg initial dose then 2 mg every 30 seconds to 1 minute for conscious sedation.
	* If mechanical capture present and symptoms unresolved, increase TCP by 10 BPM until improvement noted or TCP set at 80 BPM.		* If mechanical capture present and symptoms unresolved, increase TCP by 10 BPM until improvement noted or TCP set at 80 BPM.
	* 0.9% NaCl 200 - 300 ml fluid bolus.		* 0.9% NaCl 200 - 300 ml fluid bolus.

Treloars at 13:48, 24 April 2020

2020-04-24T13:48:00Z

← Older revision		Revision as of 13:48, 24 April 2020
Line 19:		Line 19:
	* If drug induced, treat as per specific drug overdose.		* If drug induced, treat as per specific drug overdose.
	** For calcium channel and beta blockers, administer [[Glucagon\|GLUCAGON]] 2mg (may repeat x 1)		** For calcium channel and beta blockers, administer [[Glucagon\|GLUCAGON]] 2mg (may repeat x 1)
	** For calcium channel blockers, administer [[~~Electrolytes~~\|CALCIUM CHLORIDE]] 1 gram IVP. (Avoid if patient in on digoxin or lanoxin).		** For calcium channel blockers, administer [[Calcium Chloride\|CALCIUM CHLORIDE]] 1 gram IVP. (Avoid if patient in on digoxin or lanoxin).
	** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[~~Electrolytes~~\|SODIUM BICARBONATE]], 1 mEq/kg IVP.		** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[Sodium Bicarbonate\|SODIUM BICARBONATE]], 1 mEq/kg IVP.
	** For narcotic OD, administer [[Naloxone\|NALOXONE (NARCAN)]] 0.4 mg IVP, IO or IN start low and titrate for respiratory function improvement. Maximum total dose of 2 mg.		** For narcotic OD, administer [[Naloxone\|NALOXONE (NARCAN)]] 0.4 mg IVP, IO or IN start low and titrate for respiratory function improvement. Maximum total dose of 2 mg.

Treloars at 00:27, 24 April 2020

2020-04-24T00:27:00Z

← Older revision		Revision as of 00:27, 24 April 2020
Line 18:		Line 18:
	* If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, bypass [[Atropine\|ATROPINE SULFATE]] and proceed directly to pacing.		* If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, bypass [[Atropine\|ATROPINE SULFATE]] and proceed directly to pacing.
	* If drug induced, treat as per specific drug overdose.		* If drug induced, treat as per specific drug overdose.
	** For calcium channel and beta blockers, administer [[~~Antidiabetics~~\|GLUCAGON]] 2mg (may repeat x 1)		** For calcium channel and beta blockers, administer [[Glucagon\|GLUCAGON]] 2mg (may repeat x 1)
	** For calcium channel blockers, administer [[Electrolytes\|CALCIUM CHLORIDE]] 1 gram IVP. (Avoid if patient in on digoxin or lanoxin).		** For calcium channel blockers, administer [[Electrolytes\|CALCIUM CHLORIDE]] 1 gram IVP. (Avoid if patient in on digoxin or lanoxin).
	** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[Electrolytes\|SODIUM BICARBONATE]], 1 mEq/kg IVP.		** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[Electrolytes\|SODIUM BICARBONATE]], 1 mEq/kg IVP.

Treloars at 23:39, 23 April 2020

2020-04-23T23:39:21Z

Treloars at 21:00, 22 April 2020

2020-04-22T21:00:38Z

← Older revision		Revision as of 21:00, 22 April 2020
Line 21:		Line 21:
	** For calcium channel blockers, administer [[Electrolytes\|CALCIUM CHLORIDE]] 1 gram IVP. (Avoid if patient in on digoxin or lanoxin).		** For calcium channel blockers, administer [[Electrolytes\|CALCIUM CHLORIDE]] 1 gram IVP. (Avoid if patient in on digoxin or lanoxin).
	** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[Electrolytes\|SODIUM BICARBONATE]], 1 mEq/kg IVP.		** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[Electrolytes\|SODIUM BICARBONATE]], 1 mEq/kg IVP.
	** For narcotic OD, administer [[~~Antagonists~~\|NALOXONE (NARCAN)]] 0.4 mg IVP, IO or IN start low and titrate for respiratory function improvement. Maximum total dose of 2 mg.		** For narcotic OD, administer [[Naloxone\|NALOXONE (NARCAN)]] 0.4 mg IVP, IO or IN start low and titrate for respiratory function improvement. Maximum total dose of 2 mg.

Treloars at 20:03, 22 April 2020

2020-04-22T20:03:27Z

← Older revision		Revision as of 20:03, 22 April 2020
Line 15:		Line 15:
	* If mechanical capture present and symptoms unresolved, increase TCP by 10 BPM until improvement noted or TCP set at 80 BPM.		* If mechanical capture present and symptoms unresolved, increase TCP by 10 BPM until improvement noted or TCP set at 80 BPM.
	* 0.9% NaCl 200 - 300 ml fluid bolus.		* 0.9% NaCl 200 - 300 ml fluid bolus.
	* [[~~Adrenergics~~\|DOPAMINE]] 5 - 20 mcg / kg / minute titrated to systolic BP > 90 mm Hg.		* [[Dopamine\|DOPAMINE]] 5 - 20 mcg / kg / minute titrated to systolic BP > 90 mm Hg.
	* If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, bypass [[Antiarrhythmics\|ATROPINE SULFATE]] and proceed directly to pacing.		* If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, bypass [[Antiarrhythmics\|ATROPINE SULFATE]] and proceed directly to pacing.
	* If drug induced, treat as per specific drug overdose.		* If drug induced, treat as per specific drug overdose.

Treloars at 15:44, 1 February 2018

2018-02-01T15:44:03Z

← Older revision		Revision as of 15:44, 1 February 2018
Line 27:		Line 27:

	This Standing Order is divided between the care and treatment of the stable patient verses the unstable patient. As a matter of definition agreed upon by the Medical Directors, the UNSTABLE patient is one who presents with any of the following: '''''SIGNIFICANT CARDIAC, SUSPECTED CARDIAC, SIGNIFICANT DYSPNEA, ALTERED MENTAL STATUS, OR HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION, OR SIGNIFICANT COMPROMISE OF AIRWAY, BREATHING, AND/OR CIRCULATION.'''''		This Standing Order is divided between the care and treatment of the stable patient verses the unstable patient. As a matter of definition agreed upon by the Medical Directors, the UNSTABLE patient is one who presents with any of the following: '''''SIGNIFICANT CARDIAC, SUSPECTED CARDIAC, SIGNIFICANT DYSPNEA, ALTERED MENTAL STATUS, OR HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION, OR SIGNIFICANT COMPROMISE OF AIRWAY, BREATHING, AND/OR CIRCULATION.'''''

			[[Category:Cardiac\|0406]]

← Older revision		Revision as of 13:48, 24 April 2020
Line 19:		Line 19:
	* If drug induced, treat as per specific drug overdose.		* If drug induced, treat as per specific drug overdose.
	** For calcium channel and beta blockers, administer [[Glucagon\|GLUCAGON]] 2mg (may repeat x 1)		** For calcium channel and beta blockers, administer [[Glucagon\|GLUCAGON]] 2mg (may repeat x 1)
	** For calcium channel blockers, administer [[~~Electrolytes~~\|CALCIUM CHLORIDE]] 1 gram IVP. (Avoid if patient in on digoxin or lanoxin).		** For calcium channel blockers, administer [[Calcium Chloride\|CALCIUM CHLORIDE]] 1 gram IVP. (Avoid if patient in on digoxin or lanoxin).
	** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[~~Electrolytes~~\|SODIUM BICARBONATE]], 1 mEq/kg IVP.		** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[Sodium Bicarbonate\|SODIUM BICARBONATE]], 1 mEq/kg IVP.
	** For narcotic OD, administer [[Naloxone\|NALOXONE (NARCAN)]] 0.4 mg IVP, IO or IN start low and titrate for respiratory function improvement. Maximum total dose of 2 mg.		** For narcotic OD, administer [[Naloxone\|NALOXONE (NARCAN)]] 0.4 mg IVP, IO or IN start low and titrate for respiratory function improvement. Maximum total dose of 2 mg.

← Older revision		Revision as of 00:27, 24 April 2020
Line 18:		Line 18:
	* If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, bypass [[Atropine\|ATROPINE SULFATE]] and proceed directly to pacing.		* If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, bypass [[Atropine\|ATROPINE SULFATE]] and proceed directly to pacing.
	* If drug induced, treat as per specific drug overdose.		* If drug induced, treat as per specific drug overdose.
	** For calcium channel and beta blockers, administer [[~~Antidiabetics~~\|GLUCAGON]] 2mg (may repeat x 1)		** For calcium channel and beta blockers, administer [[Glucagon\|GLUCAGON]] 2mg (may repeat x 1)
	** For calcium channel blockers, administer [[Electrolytes\|CALCIUM CHLORIDE]] 1 gram IVP. (Avoid if patient in on digoxin or lanoxin).		** For calcium channel blockers, administer [[Electrolytes\|CALCIUM CHLORIDE]] 1 gram IVP. (Avoid if patient in on digoxin or lanoxin).
	** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[Electrolytes\|SODIUM BICARBONATE]], 1 mEq/kg IVP.		** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[Electrolytes\|SODIUM BICARBONATE]], 1 mEq/kg IVP.

← Older revision		Revision as of 21:00, 22 April 2020
Line 21:		Line 21:
	** For calcium channel blockers, administer [[Electrolytes\|CALCIUM CHLORIDE]] 1 gram IVP. (Avoid if patient in on digoxin or lanoxin).		** For calcium channel blockers, administer [[Electrolytes\|CALCIUM CHLORIDE]] 1 gram IVP. (Avoid if patient in on digoxin or lanoxin).
	** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[Electrolytes\|SODIUM BICARBONATE]], 1 mEq/kg IVP.		** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[Electrolytes\|SODIUM BICARBONATE]], 1 mEq/kg IVP.
	** For narcotic OD, administer [[~~Antagonists~~\|NALOXONE (NARCAN)]] 0.4 mg IVP, IO or IN start low and titrate for respiratory function improvement. Maximum total dose of 2 mg.		** For narcotic OD, administer [[Naloxone\|NALOXONE (NARCAN)]] 0.4 mg IVP, IO or IN start low and titrate for respiratory function improvement. Maximum total dose of 2 mg.

← Older revision		Revision as of 23:39, 23 April 2020
Line 9:		Line 9:
	'''UNSTABLE:'''		'''UNSTABLE:'''
	*Apply [[Transcutaneous Pacing Procedure\|TCP]] on stand-by.		*Apply [[Transcutaneous Pacing Procedure\|TCP]] on stand-by.
	* [[~~Antiarrhythmics~~\|ATROPINE SULFATE]] 0.5 - 1.0 mg rapid IVP		* [[Atropine\|ATROPINE SULFATE]] 0.5 - 1.0 mg rapid IVP
	* If transient increase in heart rate noted and improved patient status, Repeat [[~~Antiarrhythmics~~\|ATROPINE SULFATE]] as needed every 3 minutes to a total dose of 3.0 mg.		* If transient increase in heart rate noted and improved patient status, Repeat [[Atropine\|ATROPINE SULFATE]] as needed every 3 minutes to a total dose of 3.0 mg.
	* Initiate [[Transcutaneous Pacing Procedure\|TCP]]. Pacemaker output may cause excessive pain / distress in the conscious patient.		* Initiate [[Transcutaneous Pacing Procedure\|TCP]]. Pacemaker output may cause excessive pain / distress in the conscious patient.
	* Consider administration of [[Sedative Hypnotics\|VERSED]] 2-5 mg initial dose then 2 mg every 30 seconds to 1 minute for conscious sedation.		* Consider administration of [[Sedative Hypnotics\|VERSED]] 2-5 mg initial dose then 2 mg every 30 seconds to 1 minute for conscious sedation.
Line 16:		Line 16:
	* 0.9% NaCl 200 - 300 ml fluid bolus.		* 0.9% NaCl 200 - 300 ml fluid bolus.
	* [[Dopamine\|DOPAMINE]] 5 - 20 mcg / kg / minute titrated to systolic BP > 90 mm Hg.		* [[Dopamine\|DOPAMINE]] 5 - 20 mcg / kg / minute titrated to systolic BP > 90 mm Hg.
	* If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, bypass [[~~Antiarrhythmics~~\|ATROPINE SULFATE]] and proceed directly to pacing.		* If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, bypass [[Atropine\|ATROPINE SULFATE]] and proceed directly to pacing.
	* If drug induced, treat as per specific drug overdose.		* If drug induced, treat as per specific drug overdose.
	** For calcium channel and beta blockers, administer [[Antidiabetics\|GLUCAGON]] 2mg (may repeat x 1)		** For calcium channel and beta blockers, administer [[Antidiabetics\|GLUCAGON]] 2mg (may repeat x 1)
Line 24:		Line 24:


	'''''DO NOT GIVE [[~~Antiarrhythmics~~\|LIDOCAINE]] TO THESE RHYTHMS'''''		'''''DO NOT GIVE [[Lidocaine\|LIDOCAINE]] TO THESE RHYTHMS'''''

	This Standing Order is divided between the care and treatment of the stable patient verses the unstable patient. As a matter of definition agreed upon by the Medical Directors, the UNSTABLE patient is one who presents with any of the following: '''''SIGNIFICANT CARDIAC, SUSPECTED CARDIAC, SIGNIFICANT DYSPNEA, ALTERED MENTAL STATUS, OR HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION, OR SIGNIFICANT COMPROMISE OF AIRWAY, BREATHING, AND/OR CIRCULATION.'''''		This Standing Order is divided between the care and treatment of the stable patient verses the unstable patient. As a matter of definition agreed upon by the Medical Directors, the UNSTABLE patient is one who presents with any of the following: '''''SIGNIFICANT CARDIAC, SUSPECTED CARDIAC, SIGNIFICANT DYSPNEA, ALTERED MENTAL STATUS, OR HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION, OR SIGNIFICANT COMPROMISE OF AIRWAY, BREATHING, AND/OR CIRCULATION.'''''

	[[Category:Cardiac\|0406]]		[[Category:Cardiac\|0406]]