A 65 year old male opens his eyes when you shout his name. He tells you he feels weak and his chest hurts. Vital signs are BP 70/40, R 20, SpO2 82%. His pulse matches the monitor. What should you do?

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Multiple Choice

A 65 year old male opens his eyes when you shout his name. He tells you he feels weak and his chest hurts. Vital signs are BP 70/40, R 20, SpO2 82%. His pulse matches the monitor. What should you do?

Symptomatic bradycardia with signs of poor perfusion is the situation here. When a patient has a pulse but is hypotensive and unstable (chest pain, weakness, low blood pressure), the first-line treatment is atropine. Atropine works by blocking the parasympathetic (vagal) input to the heart, which speeds the heart rate and improves cardiac output and perfusion quickly. This addresses the underlying problem of bradycardia driving the low blood pressure and chest pain. Defibrillation and CPR are not appropriate because the patient still has a pulse, so shock or chest compressions aren’t indicated. Rapid transport remains important, but you shouldn’t delay helped bradycardia with atropine to focus only on transport. Also, while preparing to treat, give supplemental oxygen to address the marked hypoxia (SpO2 82%) and monitor closely for rhythm changes or a need to escalate care if atropine doesn’t produce an adequate response.

Symptomatic bradycardia with signs of poor perfusion is the situation here. When a patient has a pulse but is hypotensive and unstable (chest pain, weakness, low blood pressure), the first-line treatment is atropine. Atropine works by blocking the parasympathetic (vagal) input to the heart, which speeds the heart rate and improves cardiac output and perfusion quickly. This addresses the underlying problem of bradycardia driving the low blood pressure and chest pain.

Defibrillation and CPR are not appropriate because the patient still has a pulse, so shock or chest compressions aren’t indicated. Rapid transport remains important, but you shouldn’t delay helped bradycardia with atropine to focus only on transport. Also, while preparing to treat, give supplemental oxygen to address the marked hypoxia (SpO2 82%) and monitor closely for rhythm changes or a need to escalate care if atropine doesn’t produce an adequate response.

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