Determine Patient Stability

• Is bradycardia symptomatic?
• Signs of instability include hypotension, poor skin signs, shortness of breath, chest pain, evidence of CHF, or decreased mentation.

1. Evaluate ABC's, only if patient is stable should this protocol be utilized.
2. Obtain & review EKG to determine the rhythm & examine for myocardial ischemia or infarction.
1. Sinus Bradycardia: Observe
2. 1^st degree AV Block: Observe
3. 2^nd/3^rd degree AV block or junctional rhythm: Place pacer pads, but only utilize if patient becomes unstable. Cardiology Consult for possible transvenous pacer placement.
4. Have atropine available if 1^st or 2^nd degree AV block.
3. Oxygen, IV, Labs, Pulse Oximetry, CXR for any symptomatic patient or for any patient that may deteriorate.
4. Consider causes including:
• Physical conditioning
• Acute myocardial infarction (esp. inferior)
• Drugs (Beta blockers, Calcium channel blockers, Digoxin)
• 2^nd or 3^rd degree AV Block or Junctional rhythm
• Head trauma or intracerebral bleed
• Hypovolemia
• Hypoxia
• Hypothermia
• Metabolic: hyper/hypokalemia, hypercalcemia, acidosis, thyroid disease
• Hypoglycemia
• Pulmonary embolus
• Pneumothorax or Tamponade
5. Continue to monitor. Cardiology consultation and/or hospital admission if indicated.

Source: Circulation 2005;112. 2005 AHA Guidelines for CPR and ECC.