Bradycardia Quiz #3 - Learn & Master ACLS/PALS

Comments

  1. johnsa07 says

    So the order is atropine if it dont work then TCP if TCP dont work then Dopamine if dopamine dont work then epinephrine?

    • Jeff with admin. says

      This is correct except dopamine and epinephrine are both considered equally effective for pacing. This means that either could be attempted first and if it did not help then you could attempt the other.

      Kind regards,
      Jeff

    • Jeff with admin. says

      Transcutaneous pacing is performed by placing pads on top of the skin (transcutaneous). These pads conduct an electrical current that stimulate the heart to contract.
      Transvenous pacing is usually performed when transcutaneous pacing fails. This this case, electrodes are placed into the central venous system in much the same way as a central line is placed. These electrodes produce an electrical current that stimulate the heart to contract.
      Transvenous pacing is a temporary procedure that is performed until a permanent pacemaker can be placed.

      Here is a video that demonstrates placement of a transvenous pacemaker if you are interested.

      Kind regards,
      Jeff

      • folukefashakin@gmail.com says

        hello jeff. who perform this placement of the transvenous pacemaker ? a surgeon or ACLS certified person. i asked this question because I am a RN just out of curiousity

      • Jeff with admin. says

        Any physician that has been trained in the placement of a temporary transvenous pacemaker can perform this procedure.
        The placement of a permanent pacemaker is performed by a surgeon.

        Kind regards,
        Jeff

    • Jeff with admin. says

      Hi rcastelllo

      Thanks for the question.
      You asked:
      “Question 4: I thought TCP should not be used for all of the above choices.”

      Reply:
      Asystole is the only thing that was contraindicated in the answers to question #4.
      Both second degree heart block and complete heart block can be treated with transcutaneous pacing.
      Kind regards,
      Jeff

  2. MCKINNEY says

    The entire bradycardia section was great.I felt good after going over this section.I love the idea you can take the test,go over the rational,retake the test and come out feeling good about the subject matter,once again THX

  3. taniandra12@gmail.com says

    I am confused with the epinephrine dosage for bradycardia ( question 6 ) . According to the tip on cramming meds for Bradycardia you give 1 mg Epi, but the answer to the question mentioned above is 2 to 10 mcg/min. Can you explain why? Thank’s.

    • Jeff with admin. says

      In the bradycardia algorithm, epinephrine is only used as an infusion only. This infusion is meant to increase the heart rate.
      In the pulseless arrest algorithm, epinephrine is used as an IV push. This is meant to help increase blood pressure.
      You stated “According to the tip on cramming meds for bradycardia you give 1mg epi.” I’m not sure where you saw this, but there is nothing on this site in the bradycardia section that says this. 1mg doses of epinephrine are used only in the pulseless arrest algorithm.

      Please let me know if you have any other questions.
      Kind regards,
      Jeff

  4. dbrumba says

    On # 7 it appears the rate is 75 at best , but > 65, why is this strip not exhibiting sinus rhythm, and why is it considered sinus bradycardia? Is not bradycardia a rate < 60 ?

    • Jeff with admin. says

      This rhythm strip is a slightly modified image from this image.
      The rate is in the high 30’s. It is considered sinus bradycardia because the PR interval is normal and there is a p-wave generated with each QRS. When each electrical impulse is transmitted properly from the sinus node through the heart the bradycardia is considered sinus and is called sinus bradycardia.
      Kind regards,
      Jeff

      • dbrumba says

        Now that I put on my glasses and viewed the other image, I see my mistake, thanks Jeff.

    • Jeff with admin. says

      When the patient is in a hypothermic state electrical conduction across the cell membrane is greatly inhibited. TCP has not been shown to be effective for bradycardia related to hypothermia. The problem of bradycardia in a hypothermic state is best corrected by instituting rewarming measures.
      Kind regards,
      Jeff

  5. rhuzavril says

    Gudmorning’if atrophine’tcp & transvenous pacing failed what is the best to do?seek expert opinion or start dopamine infusion???..this just made me confius’..tnx!

    • Jeff with admin. says

      You would start and epinephrine or dopamine infusion per ACLS protocol. If these fail, you would need get someone to place a transvenous line for transvenous pacing and consult for pacemaker placement.
      Kind regards,
      Jeff

  6. gena foucek sinopoli says

    Jeff,
    I have taught and worked as a nurse and artist for 34 years and feel this
    is the best teaching site I have seen
    Your site is awsome
    gena

    • Jeff with admin. says

      There are cases where TCP would be appropriate for sinus bradycardia. For instance you may have a patient that has taken an overdose of a medication that slows heart rate and now they are unstable due to the effects of the medication. You could appropriately use TCP for the treatment of this unstable sinus bradycardia.

      Kind regards,
      Jeff

    • Jeff with admin. says

      Knowing the basics of EKG’S and rhythm interpretation will be mostly important fir the megacode skills station, but there may be a question or two  on the written test.

      Kind regards,
      Jeff

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