Adult Bradycardia (With Pulse)

Step 1:
Assess appropriateness for clinical condition. Heart rate typically <50/min if bradyarrhythmia.

Step 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

Step 3:
Persistent bradyarrhythmia causing:
     • Hypotension?
     • Acutely altered mental status?
     • Signs of shock?
     • Ischemic chest discomfort?
     • Acute heart failure?

Step 4:
Monitor and observe

Step 5:
Atropine
If atropine ineffective:
     • Transcutaneous pacing OR
     • Dopamine infusion OR
     • Epinephrine infusion

Step 6:
Consider:
     • Expert consultation
     • Transvenous pacing

Doses/Details
Atropine IV Dose:
First dose: 0.5mg bolus
Repeat every 3-5 minutes
Maximum: 3 mg
Dopamine IV Infusion:
2-10 mcg/kg per minute
Epinephrine IV Infusion:
2-10 mcg per minute

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