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Bradycardia in Orthopedics

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Bradycardia or a slow heart rate, is an uncommon but grave complication in the field of orthopedics. A sudden attack of bradycardia is life-threatening, and has to be managed intensively, with the help of a physician or an anesthetist. The blurring of clinical signs of bradycardia is generally due to more importance given to orthopedic injuries or a surgery which a person has undergone.

Consequences of Bradycardia

The sudden and dramatic consequences of a slow heart rate can lead to a vicious cycle of continued oxygen deficit to important body tissues, like brain, kidneys, heart, etc. Decreased blood supply to brain due to a severe attack of bradycardia, leads to a permanent impairment in the brain functions or coma within minutes. Decreased blood supply to kidneys causes inability of the body to flush out harmful bi-products, like urea, nitrogen wastes, etc., which are toxic to the body. Decreased blood supply to the heart can lead to frequent chest pains and inability to tolerate any kind of stress. Thus, bradycardia has multiple grave consequences and needs to be treated immediately.

Bradycardia in Orthopedic Injuries

Orthopedic injuries, like fractures of long bones are prone to cause damage to the fatty tissue present in the bone marrow space. Due to the high velocity nature of the trauma causing these injuries, there is a high possibility of fat embolism taking place. Fat embolism is a process in which, fat droplets gain entry into the blood, and obstruct the smaller blood vessels of the lungs. This can lead to a severe attack of bradycardia or even cardiac arrest. This type of complication typically occurs within 48-72 hours after a major orthopedic injury or fracture.

Bradycardia in Orthopedic Surgery

The complication of bradycardia can also occur during replacement surgeries, like hip replacement, knee replacement, and so on. This is mainly attributed to the process of cementing, which involves injecting the cement in bone marrow space. During this procedure, there is always a possibility of the cement gaining access to the blood. The instant allergic reaction or anaphylaxis, to the cement leads to severe bradycardia. As the patient is under anesthesia, the patient may not be able to effectively convey his complaints and can become comatose. Hence, the cementing procedure has to be carefully monitored by an anesthetist. Many centers even give injectable corticosteroids to prevent such allergic reactions.

Thus, only vigilance and prompt treatment of bradycardia can ensure a safe passage of a patient though orthopedic injuries or surgeries.

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