The next algorithm is bradycardia. That's going to be identified as a heart rate of less than 50 beats per minute less than five o beats per minute. So things to consider with bradycardia are, hey, what's causing this? You know, and we can't find the cause we need to search for the cause. So, the treatment for bradycardia is is very simple actually find the underlying cause, but also determine is your patient stable or they unstable? And by that I mean, are they hemodynamically stable or hemodynamically?

Unstable is their blood pressure less than 90 systolic is there to setlist and 94 are they showing signs and symptoms of heart failure? Are they having chest pain, shortness of breath? Are they nauseated, sweaty, pale, things like that definitely lean towards a unstable I need to fix this patient. However, if your patient is stable, they're not showing any signs or symptoms that this bradycardia affecting them. Our job now is just to monitor the patient and watch them and make sure they don't get any sicker. Now monitor doesn't mean ignore.

We still have them hooked up to the cardiac monitor, we've got an IV started. And we're just making sure that they don't get any sicker from that. So the treatment for stable bradycardia is monitoring observe, period. If they become unstable, then there's different things that we can do for unstable depending on what resources you have, and how sick your patient is. So in a real perfect world, the first medication that we would want to give to a person who is unstable and bradycardia is going to be Atrazine. Atrazine can be used on most bradycardia is typically not for a third degree heart block.

It just simply won't work. That's a whole new class, but attribute. It's an anticholinergic. So what that does, if, if that bradycardia is being stimulated by the vagus nerve, that number 10 nerve that's connected to the heart Heart, then the heart will slow down. So what, what atropine does is it actually blocks that stimulation and won't allow it to to make the heartbeat slower, therefore allowing the SA node to kick back in and do what it needs to do. That sure means a band aid they typically last about five minutes per dose.

The dose for atropine is point five milligrams, so it's a half a milligram. And you can repeat that every three to five minutes until you max out at three milligrams. So if atropine is ineffective, we may want to try an infusion of dopamine and or epinephrine. Now these aren't boluses these are infusions so they're drips so both epinephrine and dopamine have to have the same qualities pretty much they have Fina tropic qualities and crona tropic qualities. So basically what that means is Corona trophic means it makes the heartbeat faster. I in a tropic has to do with its with its squeezing of the heart.

So if we can make it squeeze tighter and beat faster We can hopefully help this patient out who is symptomatic and Breda Kartik. So here's the dose ranges that you'll need to remember for both dopamine and epinephrine. Now dopamine is your going to be your only weight based medication. So the suggested dose range is going to be two to 20 micrograms per kilogram per minute titrate to effect. If you want to use epinephrine for some reason, it's going to be two to 10 micrograms per minute, no kilos titrate to effect. If all of those are failing or your patient is really, really sick, and we're worried about them right now.

Then, the last ditch effort is to go with TCP transcutaneous pacing. That's basically us just sending electrical signals across the heart through the cardiac pads and making the heartbeat when we want it to using low voltage electricity. Your instructor will go over that very well with you. But just keep in mind that there's different levels of treatments and those sequences and it all is based on what is a With your patient at that point