Bradycardia
Bradycardia - Flowchart Bradycardia Bradycardia
«Flowchart»

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.

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

Dopamine infusion
or

Epinephrine infusion

4

Monitor and observe

4

Monitor and observe

4

4

Monitor and observe

Monitor and observe

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

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

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