In many systems, there is a debate about which treatment modality is preferred.
Either way, the patient is said to have symptomatic bradycardia.
Chest pain and shortness of breath can accompany either hemodynamically stable or unstable bradycardia.
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In unstable bradycardia, the lack of perfusion could be the cause of chest pain or dyspnea.
In stable bradycardia, other cardiac conditions could be leading to both the symptoms and the bradycardia.
Other systems consider it unstable.
Paramedics should always follow their local protocols.
First-degree AVBsimply increases the natural pause that the AV node is supposed to create.
A first degree AVB does not have much if any, the effect on the heart rate.
The rate, in this case, is still set by the sinus node situated in the right atrium.
Most first degree blocks are considered harmless.
This nuance is very important when debating whether or not to try atropine at all for complete heart blocks.
Treatment of Symptomatic Bradycardia
Stable bradycardia is addressed by treating the underlying cause of the bradycardia.
If its medication-related, removing or adjusting the medication should help.
Unstable bradycardia should be treated directly.
Decreased perfusion in the brain can lead to strokes, dizziness, or confusion.
The most successful treatment uses a combination of all three.
A bolus of IV fluid infused can help increase blood pressure and improve perfusion.
Sympathomimetic drugs may also help increase heart rate, which is the most direct treatment possible.
And now, the debate.
This is where the nuance of complete heart blocks comes in.
There are several reasons given.
The most common reason is that atropine increases oxygen use in heart muscle, which could worsen an AMI.
The second most common reason given is that atropine doesnt affect complete heart blocks.
Neither of those reasons holds up to scrutiny, however.
There is no published evidence that atropine, when administered for symptomatic bradycardia, worsens myocardial infarction.
Also, complete AVB is an extremely rare condition that is relatively easy to identify throughECG.
Using TCP is a high-acuity, low-frequency skill with significant potential for improper app.
A similar discussion, without the debate part, exists in whether to use Edison or medicine for unstabletachycardia.
The best thing to remember is to follow the American Heart Association and give atropine a try.
Evidence suggests that it wont harm the patient.
If atropine is going to work, it usually works within a minute of administration.
