From the Guidelines
When evaluating patients with bradycardia, pay attention to pauses >3 seconds and a 2-fold increase in the preceding R-R interval, as these may be associated with significant bradycardia and cardiac conduction delay. According to the 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay 1, permanent pacing has been evaluated in small numbers of patients with significant bradycardia associated with seizures. The definition of bradycardia as a pause >3 seconds and a 2-fold increase in the preceding R-R interval is crucial in identifying patients who may require further evaluation and management.
Some key points to consider when evaluating patients with bradycardia include:
- The duration of the pause, with pauses >3 seconds being more concerning
- The increase in the preceding R-R interval, with a 2-fold increase being a significant indicator of bradycardia
- The presence of associated symptoms, such as seizures or syncope
- The need for permanent pacing in patients with significant bradycardia, as evaluated in the 2018 ACC/AHA/HRS guideline 1.
In clinical practice, it is essential to carefully evaluate patients with bradycardia and cardiac conduction delay, using the definition of bradycardia as a guide, to provide appropriate management and prevent potential complications.
From the Research
Key Considerations for Implementing a Pause
When considering the implementation of a pause, such as "The Pause" after patient death, several key factors should be taken into account:
- Personal Benefits: The pause can offer benefits such as self-care and grief processing for healthcare providers 2, 3.
- Professional Benefits: It can also lead to a better work environment, increased resilience, and improved patient outcomes 2, 3.
- Implementation: The pause is a low-cost, low-risk intervention that can be implemented at an organizational level and led by any member of the care team 2, 3.
- Timing and Duration: While the exact timing and duration of the pause may vary, it is essential to provide a moment of silence to honor the patient and the healthcare team's efforts 3.
Potential Applications of the Pause
The concept of the pause can be applied in various settings, including:
- Emergency Departments: The pause can help emergency providers feel grounded after a death before treating another patient and reduce caregiver stress 3.
- Ambulatory Settings: Diagnostic pauses can be used to address diagnostic errors and improve patient safety in outpatient settings 4.
- Medical Education: Pause training can be integrated into medical curricula to promote the development of pausing skills and improve performance and patient safety 5.
Future Research Directions
Further research is needed to examine the impact of the pause on patient outcomes and workplace culture 2, as well as to explore its applications in different healthcare settings and its potential to reduce burnout and improve retention among healthcare providers 2, 3.