Adult Bradycardia (With Pulse) Algorithm
Adult Bradycardia (With Pulse) Algorithm - Flowchart
«Flowchart»

Adult Bradycardia With a Pulse Algorithm

Adult Bradycardia With a Pulse Algorithm

Adult Bradycardia With a Pulse Algorithm

Adult Bradycardia With a Pulse Algorithm

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
If atropine ineffective:

Atropine


Transcutaneous pacing
or
Dopamine infusion
or
Epinephrine infusion


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

4

Monitor and observe

4

Monitor and observe

4

4

Monitor and observe

Monitor and observe

1

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

1

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

1

1

Assess appropriateness for clinical condition. Heart rate typically <50/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

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

6

Consider:


Expert consultation
Transvenous pacing

6

Consider:


Expert consultation
Transvenous pacing

6

6

Consider:

Consider:


Expert consultation
Transvenous pacing


Expert consultation
Transvenous pacing

End

End

End

*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 slowly.

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 slowly.

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 slowly.

Dopamine IV infusion:

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

Epinephrine IV infusion: