Adult Cardiac Section Protocols °) 3 or °, ial infarction 2 , or ° 1 ( s syndrome s ker failure and / Protocol radycardia l cord lesion xia thermia d injury (elevated ICP) or Stroke Appropriate Airway Respiratory Distress Acute myocard Hypo Pacema Hypo Sinus b Athletes Hea Spina Sick sinu AV blocks Overdose · Differential · · · · · · · · · · YES , acute , , ) AVB

or Shock rd chest pain , syncope, or 3 , IO ProcedureIO , or nd minute and 2 / Syncope P , seizures , NO YES Protocol 12 e mental status Acute AMS, Chest Pain iratory distress tension or Shock Cardiac Monitor Symptomatic st pain st < 60/min withhypotension Seizures Work of Breathing , Dyspnea Increased / Transcutaneous Pacing 12 LeadProcedure ECG especially withhypoxia HR acute CHF altered status mental shock secondary to bradycardia Che Resp Hypo Altered Syncop Notify Destination or secondary to bradycardia

If not responsiveIf to Atropine

Contact Medical Control Heart Rate < 60 Consider earlier in

Signs and Symptoms Signs · · · · · ·

Hypotension, IV Procedure Acute CHF I I P P P B P NO Pulse Present Pulse ; Bradycardia / -Blocker l history Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS -Blockers ker cium channel blockers nidine oxin Follow cations Blocker Clo Dig Beta Cal Protocol Overdose Exit to Toxic Ingestion Toxic Ingestion Pacema · Past medica Medi · · · Protocol Appropriate or Calcium Channel · History · · P Suspected Beta Bradycardia; Pulse Present Adult Cardiac Section Protocols Adult Cardiac Section

Pearls · Recommended Exam: Mental Status, Neck, Heart, Lungs, Neuro · Bradycardia causing symptoms is typically < 50/minute. Rhythm should be interpreted in the context of symptoms and pharmacological treatment given only when symptomatic, otherwise monitor and reassess. · Identifying signs and symptoms of poor perfusion caused by bradycardia are paramount. · Atropine: Caution in setting of acute MI. The use of Atropine for PVCs in the presence of a MI may worsen heart damage. Should not delay Transcutaneous Pacing with poor perfusion. Ineffective in cardiac transplantation. · Utilize transcutaneous pacing early if no response to atropine. If time allows transport to specialty center as transcutaneous pacing is a temporizing measure and patient will likely require transvenous pacemaker. · Wide complex, bizarre appearance of complex with slow rhythm consider hyperkalemia. · Consider treatable causes for bradycardia (Beta Blocker OD, Calcium Channel Blocker OD, etc.) · Hypoxemia is a common cause of bradycardia be sure to oxygenate the patient and support respiratory effort. Protocol 12 Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS