ACLS Megacode 2: Bradycardia

A 58-year-old female with history of hypertension and diabetes presents for evaluation of lightheadedness.

Initial vitals:

T: 36.5, BP: 140/70, R: 22 P: 34, O₂: 100%

While an IV is placed, the patient is attached to a monitor.

You appreciate the following rhythm:

You give atropine without response in heart rate.

Patient begins to feel more light-headed and feels like she is going to pace out. Rhythm strip remains unchanged. Repeat vitals demonstrate a thready pulse and BP: 70/30.

You attempt to transcutaneously pace the patient but are unable to capture and patient remains persistently bradycardia and hypotensive.

You are attempting transcutaneous pacing but the patient remains persistently bradycardic.

You attempt dopamine infusion but patient remains bradycardia. The patient now has become completely unresponsive and you are unable to palpate a pulse.

Rhythm strip demonstrates the following:

You continue CPR.

On re-evaluation, the monitor demonstrates the following:

The patient regains a pulse.