How is bradycardia treated/approached in a trauma patient?

• A. Anticholinergics
• B. Treat hypercapnia
• C. Rewarm patient
• D. Pacing

Answer: (A)

Bradycardia in trauma is often driven by increased vagal (parasympathetic) tone affecting the SA and AV nodes. The quickest way to counteract that is with an anticholinergic drug, which blocks muscarinic receptors and removes the parasympathetic brake on the heart. This helps raise the heart rate and improves conduction, making anticholinergic therapy the best initial approach when a trauma patient becomes hemodynamically unstable due to bradycardia.

In practice, atropine is the classic agent used for this purpose because it acts rapidly and directly on the heart’s conduction system. If bradycardia persists after this measure, or if there is a high-grade AV block, pacing (transcutaneous or transvenous) is then considered. It's also important to address contributing reversible causes in trauma—hypoxia, hypothermia, and metabolic derangements like hypercapnia or acidosis—as these can underlie or worsen bradycardia and require separate treatment or correction.