Bradycardia with Pulse

Bradycardia with Pulse - Flowchart Bradycardia with Pulse Bradycardia with Pulse

Flowchart

Bradycardia Algorithm

Assess using the ABCDE approach
Give oxygen if appropriate and obtain IV access
Monitor ECG, BP, SpO₂, record 12-lead ECG
Identify and treat reversible causes (e.g. electrolyte abnormalities)

Bradycardia Algorithm

Assess using the ABCDE approach
Give oxygen if appropriate and obtain IV access
Monitor ECG, BP, SpO₂, record 12-lead ECG
Identify and treat reversible causes (e.g. electrolyte abnormalities)

Bradycardia Algorithm

Assess using the ABCDE approach
Give oxygen if appropriate and obtain IV access
Monitor ECG, BP, SpO₂, record 12-lead ECG
Identify and treat reversible causes (e.g. electrolyte abnormalities)

Assess using the ABCDE approach
Give oxygen if appropriate and obtain IV access
Monitor ECG, BP, SpO₂, record 12-lead ECG ₂
Identify and treat reversible causes (e.g. electrolyte abnormalities)

Atropine 500 µgm IV

End

Observe

Interim measures:

Atropine 0.5 mg IV repeat to maximum of 3 mg
Isoprenaline 5 µgm min-1 IV
Adrenaline 2-10 ncg min-IV
Alternative drugs^*

OR

Transcutaneous pacing

Interim measures:

Atropine 0.5 mg IV repeat to maximum of 3 mg
Isoprenaline 5 µgm min-1 IV
Adrenaline 2-10 ncg min-IV
Alternative drugs^*

OR

Transcutaneous pacing

Interim measures:

Atropine 0.5 mg IV repeat to maximum of 3 mg
Isoprenaline 5 µgm min-1 IV
Adrenaline 2-10 ncg min-IV
Alternative drugs^*

Atropine 0.5 mg IV repeat to maximum of 3 mg
Isoprenaline 5 µgm min-1 IV
Adrenaline 2-10 ncg min-IV
Alternative drugs^* ^* ^*

OR

Transcutaneous pacing

Seek expert help
Arrange transvenous pacing

^* Alternative include:

Aminophylline
Dopamine
Glucagon (if bradycardia due to beta-blocker or calcium channel blocker)
Glycopyrrolate can be used instead of atropine

^* Alternative include:

Aminophylline
Dopamine
Glucagon (if bradycardia due to beta-blocker or calcium channel blocker)
Glycopyrrolate can be used instead of atropine

^* Alternative include:

^* Alternative include: ^*

Aminophylline
Dopamine
Glucagon (if bradycardia due to beta-blocker or calcium channel blocker)
Glycopyrrolate can be used instead of atropine

Risk of asystole?

Recent asystole
Mobitz II AV block
Complete heart block with broad QRS
Ventricular pause >3s

Risk of asystole?

Recent asystole
Mobitz II AV block
Complete heart block with broad QRS
Ventricular pause >3s

Risk of asystole?

Recent asystole
Mobitz II AV block
Complete heart block with broad QRS
Ventricular pause >3s

YES

Assess for evidence of adverse signs

Shock
Myocardial ischaemia
Syncope
Heart failure

YES

Satisfactory response?

YES