Scenario setup
The learner is called to evaluate an adult patient with weakness, dizziness, chest pressure, and poor perfusion. The monitor shows a slow rhythm consistent with high-grade AV block.
Initial monitor
- Rhythm: third-degree heart block
- Heart rate: 38/min
- Blood pressure: 82/48
- SpO2: 94%
- Respiratory rate: 18/min
- EtCO2: 33 mmHg if using capnography
Expected learner actions
- Recognize unstable bradycardia and poor perfusion.
- Apply oxygen and monitor airway/breathing as needed.
- Prepare transcutaneous pacing without delaying for repeated medication attempts.
- Set pacer rate, increase milliamps, and identify electrical and mechanical capture.
- Reassess blood pressure, mental status, pulse quality, and pain/sedation needs.
Instructor changes
If pacing is delayed, trend blood pressure downward and add worsening mentation. When pacing capture is achieved, increase HR to the paced rate and improve blood pressure over the next minute.