Evaluation and management of bradydysrhythmias in the emergency department

Bradydysrhythmias represent a collection of cardiac conduction abnormalities that span the spectrum of emergency presentations, from relatively benign conditions to conditions that represent serious, life-threatening emergencies. This review presents the electrocardiographic findings seen in common bradydysrhythmias and emphasizes prompt recognition of these patterns. Underlying etiologies that may accompany these conduction abnormalities are discussed, including bradydysrhythmias that are reflex mediated (including trauma induced) and those with metabolic, environmental, infectious, and toxicologic causes. Evidence regarding the management of bradydysrhythmias in the emergency department is limited; however, there are data to guide the approach to the unstable bradycardic patient. When decreased end-organ perfusion is present, the use of atropine, beta agonists, and transcutaneous or transvenous pacing may be required.