What is included in the emergent management of third-degree atrioventricular (AV) block?

Updated: Jul 05, 2018
  • Author: Akanksha Agrawal, MBBS; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

All patients with suspected third-degree atrioventricular (AV) block (complete heart block) should be rapidly transported to the nearest available facility, receiving advanced life support (ACLS) with continuous cardiac monitoring, as per local protocols. In all patients, oxygen should be administered and intravenous (IV) access established. Avoid maneuvers likely to increase vagal tone (eg, Valsalva maneuvers, painful stimuli). Atropine can be administered but should be given cautiously.

Treatment in the emergency department (ED) should continue that already established in the prehospital setting, which includes administering oxygen, maintenance of an IV line, frequent monitoring of blood pressure, and continuous cardiac monitoring. Transcutaneous pacing pads should be applied and tested, if this has not already been done.

All patients with third-degree heart block need to be admitted to either a telemetry floor (if hemodynamically stable and transcutaneous pacing achieves capture) or an intensive care unit (ICU). The decision between the two locations should be made in conjunction with the cardiologist. Any patient who is hemodynamically unstable, has persistent complete heart block, has electrolyte abnormalities, or who is in complete heart block as a result of an overdose or myocardial infarction should be admitted to the ICU.

Patients may be transferred to a higher level of care if the hospital does not have intensive care capabilities or if appropriate consultation services (eg, cardiology) are not available.


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