HR<50/min
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:
• Hypotension?
• 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
or
Epinephrine Infusion – 2 to 10 mcg/ minute
Once Epinephrine makes HR go above the HR set for Pacer, Turn off the Pacer.
↓
Consider:
• Expert consultation
• Transvenous pacing
—–
Tip to remember: BAPDEE
B-Bradycardia
A-Atropine
P-Pacing
D-Dopamine infusion
E-Epinephrine infusion
E-Expert consultation
