ACLS Bradycardia Quiz #2 - Learn & Master ACLS/PALS


  1. Msrikureja says


    TCP is a treatment that will bridge to the IV pacing, which is the treatment of choice if this is a cardiac center.

    • ACLS says

      American heart Association recommendations place transcutaneous pacing as the treatment of choice in emergent settings because of its use of application. Kind regards, Jeff

  2. Yvonne Wilson says

    Jeff, you’re a miracle worker. Thanks for helping me really “lock in” these concepts with great resources and explanations. I realized I had relied too heavily on rote memorization for most of these years, but your work finally made everything crystal clear. Thank you for all you do!

    • ACLS says

      Hi Yvonne,
      That’s great! Thanks so much for your comment! I’m so glad that the site has been so helpful for you.
      Kind regards, Jeff

      • ACLS says

        You are using a provider manual that is out of date. The new dose for single doses of atropine is 1 mg and the maximum total that can be given remains 3 mg.

        Kind regards,

    • Jeff with admin. says

      The standard concentration for a dopamine drip is 800mg in 500 ml D5W or 1600 mcg/ ml. Dopamine infusion is a weight based infusion so you would need to calculate the infusion rate. For bradycardia, you will infuse at 2 to 10 mcg/kg/min and titrate based on the patient’s response.

      Here is the formula for calculating the infusion rate:

      Ordered dose x patient weight in kilograms x 60 minutes divided by the solution concentration.

      So here is an example:
      The patient weighs 50 kg and you want to infuse the drip at at 6 mcg/kg/min then you would calculate it as follows:
      6 mcg x 50 kg x 60 minutes divided by 1600 mcg/ml = 11.25 ml/hr

      The standard concentration for an epinephrine drip is 3mg in 250 ml D5W or 3000 mcg/250 ml = 12 mcg/ml. So if you want your epinephrine infusion to run at 6 mcg/min then you would calculate it as follows. First, to simplify the drip calculation for any drug ordered as mcg/minute calculate the infusion rate for 1 mcg/minute of 3000 mcg/250 ml solution (12 mcg/ml) as shown here:
      1 mcg x 60 min
      ———————— = 5 ml/hour (infusion rate)
      12 mcg/ml (drug concentration)
      Once you’ve calculated the infusion rate for 1 mcg/min which is 5 ml/hour, you can
      easily determine the titration rates, as shown below:
      2 mcg x 5 = 10 ml/hour (2 mcg/minute)
      3 mcg x 5 = 15 ml/hour (3 mcg/minute)
      4 mcg x 5 = 20 ml/hour (4 mcg/minute)
      5 mcg x 5 = 25 ml/hour (5 mcg/minute)

      Kind regards,

  3. Roberta Armstrong says

    I recall three different answers to using epi for brady 1. epi 2-10 mcg/kg and 2-10 mcg /min. and 2-20 mcg/min what is correct?

  4. Andres says

    Isn’t symptomatic bradycardia by definition a bradycardia that causes symptoms directly related to the bradycardia itself? pg 122 on the manual I think. If so, then, wouldn’t option 3 be irrelevant? Thanks for all the great resources!

    • Jeff with admin. says

      There are times when a patient might have bradycardia and the symptoms are not caused by the bradycardia. Here is an example. A 45 year old male with a heart rate of 40 bpm is having chest pain and is short of breath. These symptoms may or may not be related to the bradycardia. The cause of the symptoms should be determined before the treatment is provided.

      Kind regards,

  5. Roberta Choban says

    Question 7 if transcutaneous pacing is ineffective you have the the answer as prepare for transcutaneous pacing? Please explain???

    • Jeff with admin. says

      The answer was “prepare for transVENOUS pacing.” TransVENOUS pacing is used when transcutaneous pacing is ineffective.

      With transCUTANEOUS pacing, pacer patches are placed on the exterior skin surface. And the electrical impulse is delivered through all of the tissue. There can be a high degree of electrical impedance.

      TransVENOUS pacing is when intravenous guide wire delivers electrical impulses directly into the venous system. The transmission of the electrical impulse for transVENOUSpacing is much more effective than transCUTANEOUS pacing.

      Kind Regards, Jeff

  6. jamieringel says

    The last question asks what would be the first-line treatment for symptomatic bradycardia. Is it not atropine and THEN TCP? Isn’t atropine tried first unless you’re dealing with 2nd degree Type II or 3rd degree heart block?

    • Jeff with admin. says

      The question reads: “The treatment of choice for symptomatic bradycardia with signs of poor perfusion is ___________?”
      Atropine would be the drug of choice, however, if signs of poor perfusion is present, TCP becomes the treatment of choice and should not be delayed.
      AHA ACLS Manual pg. 126 Transcutaneous pacing should not be delayed for patients who are unstable due to a slow heart rate. It is noninvasive and has a high rate of success for improving the clinical condition of patients with symptomatic bradycardia.
      Kind regards, Jeff

    • Jeff with admin. says

      With regard to a patient with symptomatic bradycardia, DNR would not be a consideration because the patient is still alive and does not need resuscitation. The patient with symptomatic bradycardia needs increased cardiac output. DNR (do not resuscitate) is only a consideration for the patient that is dead or pulseless and in need of resuscitation.

      Kind regards,

Leave a Reply

Your email address will not be published. Required fields are marked *

I accept the Privacy Policy