A 64 year old female complains of severe chest pain with nausea. She is alert, pale, and diaphoretic. Vital Signs are BP 90/56, R22. Her pulse matches the ECG below. What should you do?

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Multiple Choice

A 64 year old female complains of severe chest pain with nausea. She is alert, pale, and diaphoretic. Vital Signs are BP 90/56, R22. Her pulse matches the ECG below. What should you do?

The main issue here is symptomatic bradycardia causing poor perfusion. The patient’s chest pain, pallor, diaphoresis, and a low blood pressure point to hemodynamic instability from a slow heart rhythm. Transcutaneous pacing provides immediate external electrical stimulation to raise the heart rate and improve cardiac output, buying time to treat the underlying cause and plan definitive pacing if needed. Nitroglycerin would lower blood pressure further and is inappropriate in this hypotensive patient with a bradyarrhythmia. You’re not dealing with a pulseless patient, so CPR isn’t indicated. While monitoring ECG is important for guidance, the priority is to stabilize hemodynamics with pacing. This pacing acts as a bridge to definitive management and is the fastest way to improve perfusion in a high-grade bradycardia or symptomatic block.

The main issue here is symptomatic bradycardia causing poor perfusion. The patient’s chest pain, pallor, diaphoresis, and a low blood pressure point to hemodynamic instability from a slow heart rhythm. Transcutaneous pacing provides immediate external electrical stimulation to raise the heart rate and improve cardiac output, buying time to treat the underlying cause and plan definitive pacing if needed.

Nitroglycerin would lower blood pressure further and is inappropriate in this hypotensive patient with a bradyarrhythmia. You’re not dealing with a pulseless patient, so CPR isn’t indicated. While monitoring ECG is important for guidance, the priority is to stabilize hemodynamics with pacing. This pacing acts as a bridge to definitive management and is the fastest way to improve perfusion in a high-grade bradycardia or symptomatic block.

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