Adult Bradycardia Algorithm

HR<50/min

Identify and treat underlying cause
• Maintain patent airway; assist breathing as necessary
• Oxygen (if hypoxemic)
• Cardiac monitor to identify rhythm; monitor blood pressure and oximetry
• IV access
• 12-Lead ECG if available; don’t delay therapy
• Consider possible hypoxic and toxicologic causes

Persistent bradyarrhythmia causing:
Hypotension?
• Signs of shock?

• Ischemic chest discomfort?
• Acute heart failure?

• Acutely altered mental status

Atropine 1 mg every 3 to 5 minutes [maximum dose 3 mg]

Transcutaneous Pacing Once capture achieved, Check BP, Sedate.

Dopamine Infusion – 5 to 20 mcg/Kg/ minute

or

Epinephrine Infusion – 2 to 10 mcg/ minute

Once Epinephrine makes HR go above the HR set for Pacer, Turn off the Pacer.

Consider:
• Expert consultation
• Transvenous pacing

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Tip to remember: BAPDEE

B-Bradycardia

A-Atropine

P-Pacing

D-Dopamine infusion

E-Epinephrine infusion

E-Expert consultation

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