CPR for Bradycardia?

[akroeze]

At what point (or would you) consider performing compressions on a bradycardic pt? As in if they have a rate of 10... do you compress? Where do you draw the line?

[Ridryder 911]

I perform CPR on bradycardiac patients when there is not cerebral perfusion .. i.e. <LOC, or low coronary perfusion.

I might do this until either medications is adminsitered or pacing can be accomplished.

Be safe,

R/R 911

[vs-eh?]

PALS is < 8 years old < 60 heart rate (I believe that is our standing orders) if they are symptomatic due to bradycardia.

That is Ontario provinical too I think.

[akroeze]

PALS is < 8 years old < 60 heart rate (I believe that is our standing orders) if they are symptomatic due to bradycardia.

That is Ontario provinical too I think.

IIRC there is no allowance in Ontario protocol for CPR on an adult unless they are pulseless. But having said that, I don't think one would be faulted for doing what is in the best interest of the pt.

[WelshMedic]

OK Guys,

This post is a bit late, but beter late than never .

WHen should you commence CPR? This has to do with the level of perfusion primarily in your brain and in your body. Our bodies stop perfusing efficiently after we've dipped below a MAP of 70 mmHG (MAP- Mean Arterial Pressure),that's why we get cold extremities and suchlike. Once we start hovering aound 60 then we get into real trouble, there will be a marked change in LOC because of decreased cerebral perfusion. The goal is not to let the MAP go below 60 as then our body will shut down and we'll begin the processes that lead to MOF (Multiple Organ Failure).

But how do we measure MAP? Well, the LP12 with a NIBP capability will do it automatically for you, but otherwise:

(1xsystolic BP+2xdiastolic BP)x0.3.

eg: with a patient that has a BP of 130/80, you'll see they have no problem:

(130+160)x0.3= 87

but with someone with a BP of 60/40 it's:

(60+80)x0.3= 42

Hope this helps to clarify the situation.

Carl.

[Para-Medic]

OK Guys,

This post is a bit late, but beter late than never .

WHen should you commence CPR? This has to do with the level of perfusion primarily in your brain and in your body. Our bodies stop perfusing efficiently after we've dipped below a MAP of 70 mmHG (MAP- Mean Arterial Pressure),that's why we get cold extremities and suchlike. Once we start hovering aound 60 then we get into real trouble, there will be a marked change in LOC because of decreased cerebral perfusion. The goal is not to let the MAP go below 60 as then our body will shut down and we'll begin the processes that lead to MOF (Multiple Organ Failure).

But how do we measure MAP? Well, the LP12 with a NIBP capability will do it automatically for you, but otherwise:

(1xsystolic BP+2xdiastolic BP)x0.3.

eg: with a patient that has a BP of 130/80, you'll see they have no problem:

(130+160)x0.3= 87

but with someone with a BP of 60/40 it's:

(60+80)x0.3= 42

Hope this helps to clarify the situation.

Carl.

quick question.

If someone was showing poor MAP as you suggested you would commence CPR right? They would also have to be unconciouss and showing signs of poor perfusion too right? If this person was on a monitor and showed a heart rate of 10-15 would you want to do compressions as the monitor shows? Or just count every 2 seconds?

[WelshMedic]

Hi Para-Medic,

If you're patient is bradycardic with a frequency of 10-15 beats a minute, then the likelyhood is that the MAP will be far below the required 60 and you're unlikely to feel a carotis pulse, let alone peripheral.You're more than likely dealing with a PEA arrest. So there's your answer - treat as such, a PEA arrest.

Take Care,

Carl.