Dont let your bradycardic patient D.I.E.

At the risk of plagiarizing myself, I’d like to revisit a topic that I discussed on my personal blog a couple of years ago. The story goes that I am not very good with mnemonics. For me they are almost never useful in clinical practice, and as the patient gets sicker my chances of properly recalling the applicable mnemonic decreases exponentially. There is, however, one mnemonic that I never forget, and it’s the DIE mnemonic for bradycardia. I developed this memory aid based off a talk on bradycardia given by the great Dr. Mel Herbert, where he discusses the above differential but in a different order and with no handy catch-phrase. [D]rugs [I]schemia [E]lectrolytes When the patient in front of you is sick, these are the three common and reversible causes of bradycardia that you need to recognize in the emergency setting. Yes, there are other causes of bradycardia that should be on your differential, but what makes this list special is that all three have specific emergency treatments and the standard ACLS trio of pacing, atropine, and dopamine does little or nothing to address them. It’s okay to miss Lev’s disease in the emergency setting because the definitive treatment is contained in the usual ACLS algorithm: pacing. If you don’t recognize that your patient is hyperkalemic, however, then all the atropine and transcutaneous pacing in the world isn’t going to lower her potassium. Sick sinus syndrome isn’t a real worry for prehospita...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: 12 lead ecg Training 12-Lead ECG bradycardia hyperkalema ischemia mnemonic overdose STEMI Vince DiGiulio Source Type: research