Adult Bradycardia Algorithm


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
• Consider possible hypoxic and toxicologic causes

Persistent bradyarrhythmia causing:
• Signs of shock?

• Ischemic chest discomfort?
• Acute heart failure?

• Acutely altered mental status

Atropine 1 mg every 3 to 5 minutes [maximum dose 3 mg]

Transcutaneous Pacing Once capture achieved, Check BP, Sedate.

Dopamine Infusion – 5 to 20 mcg/Kg/ minute


Epinephrine Infusion – 2 to 10 mcg/ minute

Once Epinephrine makes HR go above the HR set for Pacer, Turn off the Pacer.

• Expert consultation
• Transvenous pacing


Tip to remember: BAPDEE




D-Dopamine infusion

E-Epinephrine infusion

E-Expert consultation

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