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Complete heart block — RCPSC EM MCQ

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ModerateCardiovascular emergenciesComplete heart blockRCPSC EM

An 83-year-old man is CTAS 2 with dizziness and near-syncope. His heart rate is 32/min, blood pressure 82/50 mmHg, and ECG shows complete heart block with a wide escape rhythm. He remains hypotensive after a small fluid bolus. What is the most appropriate initial management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: BImmediate transcutaneous pacing

Symptomatic high-grade AV block with hypotension requires urgent pacing while preparing definitive transvenous pacing. AV nodal blockers would worsen the bradycardia.

Reference: ACLS Bradycardia Algorithm; Canadian emergency medicine practice