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Medical Pearls from the Internet Medical Association

For bradycardia, consider etiology: electrolytes (hyperkalemia?), drugs (beta blockers?), ischemia. Narrow complex bradycardia => atropine (wide complex bradycardia not atropine sensitive); atropine - go slowly and start low (0.25) especially in face of ischemia. All bradyarrhythmias: Dopamine drip. Epi drip. Pacemaker.

Comment: Key steps are to determine unstable vs stable, wide or narrow, then slow or really slow. Electrolytes, drugs (beta blockers, calcium channel blockers), ischemia? Wide complex bradycardias are more serious; not atropine sensitive. Dopamine drips helpful. If all else fails: pacemaker. Transcutaneous pacemaker frequently fails; will need transvenous pacemaker.

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