– I have attached the charts and procedures the nurse educators were using and they are also posted here:

1) consider the big 4 causes of resistant bradycardia

– toxins, ischaemia, potassium, hypothermia

2) have a step-wise approach to bradycardia

– treat reversible causes

– trial of atropine

– chemical pacing: isoprenaline or adrenaline

– electrical pacing

3) hypothermia

– there are passive and active rewarming techniques

– modifications to usual resuscitation include:

– gentle handling if T < 32 (risk of VF is present but necessary procedures are necessary)

– adrenaline where T < 30 probably not useful

– in arrest where T = 30-35 deg double the time interval between doses of adrenaline (ie every 8 min)

– these types of dissections are rare, but potentially devastating

– remember to be thorough and specific with your neuro exam and try to “spot the difference” with every new case to every previous case of muscular neck pain you see

– when patients represent – think about changing something – “where else” do we need to go with this case?

– another study suggesting that rhythm control is not as important as rate control