Leading off our run of dysrhythmia protocols is our protocol for adult bradydysrhythmias. Not a ton of critical thinking to do here – if the patient is bradycardic and unstable, paramedics will administer a single dose of atropine and start transcutaneous pacing by Standing Order. Beyond that, they will contact OLMC for further medications. Personally, I’ve often encountered calls where EMS providers have only given the dose of atropine prior to calling, so I’ll tend to take the opportunity to discuss with the crew whether they should consider starting to pace prior to freely authorizing other meds. When it comes to Medical Control Options, OLMC can authorize repeat doses of atropine, boluses of calcium chloride or sodium bicarbonate, or a dopamine infusion (might this instance actually be an indication for dopamine? You decide!).
Short and sweet this week! Like most dysrhythmias, it boils down to meds and/or electricity. Just remember that if you’re electrocuting a conscious person, have some decency and consider some sedation! Another dysrhythmia is coming up next week, but until then, you’ve got www.nycremsco.org and the protocol binder to keep you company!
Dave