Case 5

Case 5

82F with bradycardia, confusion, SBP 80s.

RRT activated for bradycardia 

EKG:

Rhythm? Initial Management Steps?

Team interface prompt

The bedside nurse can help prepare pacing before the patient loses pulses.

Ask:

“Are pads on? Who can help with sedation? Who is calling cardiology/ICU?”

Do not wait until arrest to organize the room.

EKG Analysis

Options: transcutaneous pacing (+sedation), transvenous pacing (requires line, expertise)

Teaching Points:

• Complete heart block = AV dissociation.
• Atropine is reasonable in unstable bradycardia, but do not wait on it when high-grade or infranodal block is likely. Prepare pacing/pressors and transvenous pacing early.
• Always have pacing pads in place during rapid responses.
  • Transcutaneous pacing will require sedation

Case summary

Label: Complete heart block / unstable bradycardia.

Key issue: atropine is reasonable, but do not wait when high-grade block is likely; prepare pacing, pressors, and transvenous pacing early.

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