Great case of bradycardia today in the ED-requiring transvenous pacemaker....cause?? K 7.6

Some bradycardia pearls:

• The dose of atropine is 0.5 mg IV. Can be repeated.
• Heart transplant patients will not respond to atropine as the transplant is denervated. Go right to pacing.
• Consider glucagon if suspected beta blocker toxicity....and be prepared...most patients vomit!
• DON"T FORGET THE K! A frequent cause of weird and insuspected bradycardia. I have had at least 3 cases of bradycardia (two requiring TV pacemaker insertion in the ED) due to hyperK in the last 3-4 weeks.
• Capture of the ventricle occurs when the complexes on the monitor become wide (assuming they weren't already wide)
• Search for the cause (MI, tox, metabolic, etc.)