Bradycardia

Clinical Picture

-HR <60 bpm
-Nausea & vomitting, dizziness or lighteadedness.
-Sign- Altered LOC, Chest pain, Short of breath(SOB), Hypotension, pulmonary congestion, &/@ cyanosis

Immediate Interventions

-Have a patient sit or lie down in bed
-Administer supplemental oxygen
-Assess BP
-Notify physician or NP
-Obtain a 12-lead ECG
-Check for patient IV access
-Document patient's status,phone call to physician or NP, & physician @ NP response.

Focused Assessment

-Assess level of consciousness & orientation
-Assess BP & HR
-Assess respirations rate & effort; assess SaO2 if readily available
-Assess skin for colour, moistness, & temprature. Assess for associated symptoms (chest pain, SOB, hypotension)
-If patient on telemetry or cardiac monitor, assess ECG

Stabilizing & Monitoring

-Monitor VS
-Set up cardiac monitoring & monitor rate & rhythm
-Assess recent laboratory results
-Chart patient status & convey status to physician or NP

Be Prepared To

-Administer oral or IV medications as ordered
-Obtain or order laboratory tests
-Titrate oxygen to SaO2 >90%
-Obtain IV access if none available
-Assist with external pacing
-Transfer to ICU or telemetry unit

Possible Etiologies

-Medication toxicity
-Vasovagal response
-Hyperkalemia
-Hypothermia
-Hyperthyroidism
-Sepsis
-Severe infection
-Hypoglycemia
-Excellent physical condition (athletes)
-Myocardial infarction
-Shock

Different Diagnosis : Chest Pain

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MI (Myocardial Infarction)

*Onset – Sudden, lasting longer than 30 min.

*Quality – Pressure, dull, achy, tightness

*Location/Radiation – Epigastric or substernal, usually left neck, jaw, arm or back

*Exacerbating Factor – Stress, excertion, or unprovoked

Angina

*Onset – Gradual or sudden, usually brief
*Quality – Pressure, tightness
*Location/Radiation – Chest, usually left neck, jaw and arm
*Exacerbating Factor – Exertion, stress, eating, cold temperature

Pleurisy

*Onset – Rapid
*Quality – Sharp, stabbing
*Location/Radiation – Points tenderness
*Exacerbating Factor- Inspiration

Musculoskeletal

*Onset – Variable
*Quality – Sharp, dull, aching
*Location/Radiation – Localized
*Exacerbating Factor – Movement, digital pressure, inspiration

Pericarditis

*Onset – Gradual

*Quality – Sharp, pleuritic

*Location/Radiation – Precardium

*Exacerbating Factor – Supine position

Aortic Dissection

*Onset – Sudden/Severe
*Quality – Tearing
*Location/Radiation – Chest, back
*Exacerbating Factor – Hypertension, smoking

Pulmonary Embolism

*Onset – Sudden
*Quality – Sharp-knife like, stabbing, pleuritic

*Location – Chest,back, over lungs area

*Exacerbating Factors – Dislodged thrombi, atrial fibrillation

Esophageal Ruptured

*Onset – Sudden/severe
*Quality – Sharp, burning
*Location/Radiation – Chest, throat, back
*Exacerbating Factors – Swallowing, vomitting