Can’t it be Spring Yet?

This was taken a couple of mornings ago. I couldn’t believe my eyes at 4 am. It was really snowing. After walking home, this was the aftermath outside my window.

Things in the ED have been eerily quiet. My preceptor is sure that shit is going to hit the fan soon. While we waited for patients to stroll in, the nurses and I went over some basic ACLS knowledge. ACLS is short for “advanced cardiac life support.” By no means am I expected to know all of this. It’s an extra course that is taught after becoming an RN. But if you’re going to be working in an emergency setting, you better know some of it before starting.

Firstly, we should know how to put on a 12-lead ECG.  There is a great guide here. Or if you are more of a visual learner, you can use this. Getting a basic feel of the intercostal spaces, and getting comfortable placing electrodes is important.

Next is knowing the normals. Tachycardia for adults is > 100 BPM. And bradycardia is < 60 BPM.

Here’s a handy chart to refresh your memory for paediatrics.

Age (yr) Respiratory Rate (breaths/min) Heart Rate (beats/min)
<1 30-60 100-160
1-2 24-40 90-150
2-5 22-34 80-140
6-12 18-30 70-120
>12 12-16 60-100
Lower limits of systolic pressure†
0-28 days: 60 mmHg

1-12 months: 70 mm Hg

1-10 years: 70 mm Hg + (2¥ age in years)

Reference: Rosen’s Emergency Medicine: Concepts and Clinical Practice 5th Edition

Now having a grasp of normal, when a patient comes in with a heart rate of 28 BPM. What do you think we should do? Obviously, they are bradycardic. There is actually an ACLS algorithm for bradycardia. The locum nurse that was working that night went through cardiac pacing with me. Pretty much you put pads on the patient, sync the patient to the monitor, and the AED will send low electrical shocks to the heart to try to establish a normal heart rate. Think pacemaker — but externally controlled. Wild, eh?

Note to self: Write about cardioversion in next blog. Exciting stuff!

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