Bradycardia

Bradycardia is a medical condition characterized by a slower-than-normal heart rate. Specifically, it is defined as a heart rate that is less than 60 beats per minute in adults. Our ACLS scenario-based practice questionnaire exclusively focuses on Bradycardia. Through these scenarios, you’ll develop a deeper understanding of how to assess and manage bradycardia effectively. Participate to enhance your skills to bradycardia-related emergencies.

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1

What is the most appropriate initial treatment for this patient?

A 68-year-old male with a history of heart disease presents with dizziness and fatigue. His ECG shows a heart rate of 45 bpm with regular rhythm. He is alert but complains of lightheadedness.

Hint: The patient’s symptoms and ECG findings suggest a slow heart rate that may require medication to increase the heart rate.
2

What is the immediate next step in the management of this patient?

A 55-year-old female collapses during a meeting. She is unresponsive with a heart rate of 40 bpm and hypotension. ECG shows bradycardia with a wide QRS complex.

Hint: The patient's wide QRS complex bradycardia and hypotension indicate a need for immediate intervention to regulate the heart's electrical activity.
3

What is the recommended medication for symptomatic bradycardia in this patient?

A 72-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents with bradycardia and confusion. His heart rate is 38 bpm and his blood pressure is stable.

Hint: The medication should help increase heart rate and improve symptoms related to bradycardia, especially when the patient is symptomatic but has stable blood pressure.
4

What should be administered to counteract the effects of the beta-blocker?

A 60-year-old woman is experiencing severe bradycardia and syncope. She is currently taking a beta-blocker. Her heart rate is 30 bpm and her blood pressure is low. However there is suspicion the patient may have taken more than her usual dose.

Hint: This medication bypasses the beta blockade and helps increase the heart's force of contraction.
5

Which treatment should be considered next?

A 50-year-old male with bradycardia has been unresponsive to atropine and continues to have symptoms of shock. His ECG shows a slow, regular rhythm.

Hint: Given that atropine has been ineffective and the patient continues to experience symptoms of shock, the next step should involve a method to directly control and regulate the heart's electrical activity.
6

How should you manage this patient’s bradycardia during surgery?

A 63-year-old female is undergoing surgery and her ECG shows a heart rate of 42 bpm with a stable blood pressure. She is asymptomatic.

Hint: The patient’s stable blood pressure and absence of symptoms suggest that immediate intervention may not be necessary, but careful monitoring is essential.
7

What is the best initial treatment for this patient?

A 70-year-old male presents with altered mental status and bradycardia. His ECG shows a junctional rhythm with a rate of 50 bpm.

Hint: The treatment should focus on increasing the heart rate to alleviate the symptoms associated with bradycardia.
8

What is the recommended treatment for bradycardia caused by digoxin toxicity?

A 65-year-old woman presents with bradycardia due to an overdose of digoxin. She is symptomatic with dizziness and shortness of breath.

Hint: The treatment should specifically target and neutralize the effects of digoxin toxicity to alleviate the symptoms of bradycardia.
9

Which of the following is the most appropriate action for this patient?

A 77-year-old man with a history of heart failure is found to have bradycardia and is confused. His heart rate is 38 bpm and his blood pressure is low.

Hint: The treatment should address the bradycardia directly and improve the patient’s symptoms of confusion and low heart rate.
10

What should be considered as part of the treatment plan?

A 62-year-old female in the emergency department presents with bradycardia, chest pain, and a heart rate of 42 bpm. She has a history of hypothyroidism.

Hint: The treatment should focus on increasing the heart rate and improving circulation in the context of bradycardia and chest pain.

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