Bradycardia
Bradycardia in theatre should not be treated as an isolated variable: remember to tailor treatment to the patient and the situation. Follow the full steps to exclude a serious underlying problem.
Give atropine 20 µg.kg⁻¹ (adult 0.5–1 mg) with fluid flush.
If no pulse: (or heart rate <60 bpm infant or neonate):
Delegate (minimum) 1 person to chest compressions
→ 2-1 Cardiac arrest
Glycopyrrolate 5 µg.kg⁻¹ (adult 200–400 µg)
Ephedrine 100 µg.kg⁻¹ (adult 3–12 mg)
Atropine 10 µg.kg⁻¹ (adult 300–600 µg)
Isoprenaline 0.5 µg.kg.min⁻¹ (adult 5 µg.min⁻¹)
Adrenaline 1 µg.kg⁻¹ (adult 10–100 µg) in emergency only
Consider whether you could have made a drug error.
Consider known drug causes (e.g. remifentanil, digoxin etc).
Surgical stimulation with inadequate depth.
Also consider: high intrathoracic pressure; pneumoperitoneum; local anaesthetic toxicity (→ 3-10); beta-blocker; digoxin; calcium channel blocker; myocardial infarction, hyperkalaemia, hypothermia, raised intra-cranial pressure.
Attach pads and ECG leads from pacing defibrillator.
Set to PACING MODE.
Set PACER RATE.
Increase PACER OUTPUT from 60 mA until capture (spikes align QRS).
Confirm capture: electrical AND mechanical (femoral pulse).
Set PACER OUTPUT 10 mA above capture.