Laboratory Data

1. ECG. Will differentiate sinus bradycardia from complete heart block.

2. Blood gas analysis. Will confirm hypoxemia or acidosis.

C. Radiographic and Other Studies. Chest x-ray may reveal car-diomegaly, congenital heart defect, or CHF.

V. Plan. Figure I-3 depicts an approach to the patient with bradycardia.

A. Support ABCs. Secure airway, administer 100% oxygen, and obtain IV access.

B. Attach patient to a cardiorespiratory monitor or defibrillator.

C. If patient remains hemodynamically compromised despite adequate ventilation and oxygenation, begin chest compressions.

D. identify and treat possible causes of bradycardia (6 H's and a T; see III, earlier). Refer to Figure i-3.

E. If patient does not improve, administer epinephrine or atropine, or both.

F. If patient remains bradycardic or has a history of cardiac disease, consult a cardiologist emergently. For complete heart block, consider isoproterenol, epinephrine infusion, or transcutaneous or transthoracic cardiac pacing.

VI. Problem Case Diagnosis. The 9-month-old infant was in respiratory distress and hemodynamically compromised when admitted to the emergency department. Endotracheal intubation was performed and

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