The nurse identifies the first-degree AV block occurs when all atrial impulses are carried slower than normal through the AV node into the ventricles. As a result, the PR interval is increased (>0.20 seconds).
Management of Atrioventricular block
- First-degree AV block and second-degree AV block Mobitz type I are treated only if symptomatic
- Second-degree AV block Mobitz type II and third-degree AV block are virtually always treated with a pacemaker.
In the acute situation, treatment focuses on controlling bradycardia and low cardiac output.
- Begin with 0.5 mg iv atropine (may be repeated).
- If the block is in the AV node, atropine will have an impact.
- It should be noted that atropine may worsen the block if it is administered distally to the AV node.
- Isoprenaline (isoproterenol at a rate of 5 micrograms per minute) may also be used (with caution in case of acute coronary syndromes, as isoprenaline may trigger ventricular tachycardia).
- If sinus bradycardia or asystole continues despite atropine and isoprenaline treatment, a transcutaneous or transvenous pacemaker should be used.
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