Adult Bradycardia with a Pulse Algorithm
Adult Bradycardia with a Pulse Algorithm - Flowchart ACLS Algorithm ACLS Algorithm
«Flowchart»

1

Assess appropriateness for clinical condition. Heart rate typically <50 beats/min if bradyarrhythmia.

1

Assess appropriateness for clinical condition. Heart rate typically <50 beats/min if bradyarrhythmia.

1

1

Assess appropriateness for clinical condition. Heart rate typically <50 beats/min if bradyarrhythmia.

2

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

2

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

2

2

Identify and treat underlying cause

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


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

4

Monitor and observe

4

Monitor and observe

4

4

Monitor and observe

Monitor and observe

5

Atropine

If atropine ineffective:


Transcutaneous pacing
or
Dopamine infusion
or
Epinephrine infusion

5

Atropine

If atropine ineffective:


Transcutaneous pacing
or
Dopamine infusion
or
Epinephrine infusion

5

5

Atropine

Atropine

If atropine ineffective:


Transcutaneous pacing
or
Dopamine infusion
or
Epinephrine infusion


Transcutaneous pacing
or
or or
Dopamine infusion
or Dopamine
or or
Epinephrine infusion Epinephrine

End

End

End

6

Consider:


Expert consultation
Transvenous pacing

6

Consider:


Expert consultation
Transvenous pacing

6

6

Consider:

Consider:


Expert consultation
Transvenous pacing


Expert consultation
Transvenous pacing

Doses/Details

Atropine IV dose: First dose: 0.5 mg bolus. Repeat every 3-5 minutes. Maximum: 3 mg

Dopamine IV infusion: Usual infusion rate is 2-20 mcg/kg per minute. Titrate to patient response; taper slowely.

Epinephrine IV infusion: 2-10 mcg per minute infusion. Titrate to patient response

Doses/Details

Atropine IV dose: First dose: 0.5 mg bolus. Repeat every 3-5 minutes. Maximum: 3 mg

Dopamine IV infusion: Usual infusion rate is 2-20 mcg/kg per minute. Titrate to patient response; taper slowely.

Epinephrine IV infusion: 2-10 mcg per minute infusion. Titrate to patient response

Doses/Details

Doses/Details

Atropine IV dose: First dose: 0.5 mg bolus. Repeat every 3-5 minutes. Maximum: 3 mg

Atropine IV dose:

Dopamine IV infusion: Usual infusion rate is 2-20 mcg/kg per minute. Titrate to patient response; taper slowely.

Dopamine IV infusion

Epinephrine IV infusion: 2-10 mcg per minute infusion. Titrate to patient response

Epinephrine IV infusion

3

Persistent bradyarrhythmia causing:


Hypotension?
Acutely altered mental status?
Signs of shock?
Ischemic chest discomfort?
Acute heart failure?

3

Persistent bradyarrhythmia causing:


Hypotension?
Acutely altered mental status?
Signs of shock?
Ischemic chest discomfort?
Acute heart failure?

3

3

Persistent bradyarrhythmia causing:

Persistent bradyarrhythmia causing:


Hypotension?
Acutely altered mental status?
Signs of shock?
Ischemic chest discomfort?
Acute heart failure?


Hypotension?
Acutely altered mental status?
Signs of shock?
Ischemic chest discomfort?
Acute heart failure?

Yes

Yes

Yes Yes

No

No

No No