Round 19 (Bradycardia)

Summary: <br> CAUTION: THESE NOTES CONTAIN SPOILERS!!!<br> <br> <br> <br> Case Introduction<br> <br> <br> <br> You are working a shift at EM Clerkshift General when you are called to the resuscitation bay to see an elderly patient with unstable vitals brought in by EMS. <br> <br> <br> <br> Initial Vitals<br> <br> <br> <br> * Temp 98.0F* HR 43* RR 18* BP 60/40* O2 98%<br> <br> <br> <br> Critical Actions<br> <br> <br> <br> * Diagnose the etiology for the bradycardia (BB overdose)* Administer Atropine* Administer Glucagon* Administer Epinephrine drip* Attempt transcutaneous/transvenous pacing* Administer high-dose Insulin therapy<br> <br> <br> <br> Final Diagnosis<br> <br> <br> <br> Beta Blocker Overdose<br> <br> <br> <br> Tips and Tricks<br> <br> <br> <br> * Keep in mind the broad differential for severe bradycardia – ischemia, ingestion, electrolyte abnormalities, intrinsic arrhythmia/heart block, hypothyroidism, hypothermia, hypoglycemia, hypoxia, increased intracranial pressure, neurogenic shock. <br> <br> <br> <br> Further Reading<br> <br> <br> <br> <a href="https://emcrit.org/toxhound/hdi-vs-pressor/">High Dose Insulin Therapy (EMCRIT)</a><br> <br> <br> <br> <a href="https://emergencymedicinecases.com/low-slow-poisoning/">Low and Slow Poisoning (EMCASES)</a><br>