EMRA Simulation Guide

CARDIOVASCULAR - Heart Block (Mobitz Type I)

CASE: 64-year-old male presents with weakness and diaphoresis

Learning Objectives

1. Manage a patient with symptomatic bradycardia
2. Create a broad differential for a patient with bradycardia
3. Order appropriate studies to elucidate the cause of patient’s clinical deterioration
4. Recognize need for early consultation
5. Perform transcutaneous pacing

Critical Actions

• Obtain IV access with two large-bore peripheral IVs
• Early fingerstick glucose
• Place patient on cardiac monitor with continuous oxygen saturation monitoring
• Ask for a full set of vital signs including HR, BP, oxygen saturation, and temperature
• Ask for and interpret appropriate labs (CBC, Coagulation Profile, Cardiac Biomarkers, Chemistry)
• Administer atropine
• Perform transcutaneous pacing
• Counsel patient
• Provide analgesia
• Check for mechanical capture
• Obtain EKG, CXR
• Reassess patient and vital signs
• Call appropriate consultations (Cardiology, ICU)
• Use closed-loop communication
• Summarize case to team or consultant
• Bonus: Prepare for transvenous pacing

Download the case here.