Hypotension. Third-degree heart block. Syncope.

Elderly patient with syncope. Found to be in third-degree heart block. Unstable requiring pacing. Initial management includes ACLS approach with transcutaneous pacing. Upon stabilization, the objective is placement of a transvenous pacemaker for transport to a higher level of care for permanent pacemaker insertion.

Goals and Objectives

Educational Goal:

• Approach to unstable bradycardia.

Objectives (Medical and CRM):

• ACLS bradycardia management.
• Technical aspects to starting transcutaneous and transvenous pacing.

EPAs Assessed:

• ACLS approach to bradycardia, recognizing the need for pacing and description of technical aspects (transcutaneous & transvenous), coordinating transfer for permanent pacemaker insertion.