Bradycardia
Heart rate < 60 beats/min and inadequate for clinical condition

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Maintain patent airway; assist breathing as needed.
Give oxygen.
Monitor ECG (identify rhythm), blood pressure, oximetry.
Establish I.V. access.

Observe and monitor.

Prepare for transcutaneous pacing; use without delay for high-degree block (type II second-degree block or third-degree AV block).
Consider atropine while awaiting pacer. May repeat to a total dose of 3 mg. If ineffective, begin pacing.
Consider epinephrine or dopamine infusion while awaiting pacer or if pacing is ineffective.

Prepare for transvenous pacing.
Treat contributing causes.
Consider expert consultation.

Signs or symptoms of poor perfusion caused by bradycardia

(acute altered mental status, ongoing chest pain,hypotension,

or other signs of shock)?

ADEQUATE PERFUSION

POOR PERFUSION

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