ACLS — Bradycardia
Symptomatic bradycardia management — atropine, pacing, and vasopressors
Overview
- Symptomatic bradycardia management — atropine, pacing, and vasopressors
Protocol steps
- id: 1; title: Identify and Treat Underlying Cause; detail: Assess: HR <50 with symptoms? Hypotension, altered mental status, chest pain, syncope, signs of shock? If asymptomatic with stable vitals, observe.; time: ; drugs:
- id: 2; title: Atropine First Line; detail: If unstable (hypotension, AMS, chest pain, syncope). May not be effective in Mobitz II or 3rd degree block.; time: ; drugs: name: Atropine; dose: 1mg IV; interval: q3-5min, max 3mg total
- id: 3; title: Atropine Fails — Escalate; detail: If atropine ineffective or inappropriate (high-degree block), proceed to transcutaneous pacing or vasopressor drip.; time: ; drugs: name: Dopamine; dose: 2-20 mcg/kg/min IV drip; interval: titrate to HR and BP; name: Epinephrine; dose: 0.1-0.5 mcg/kg/min IV drip; interval: alternative to dopamine; branch: true
- id: 4; title: Transcutaneous Pacing; detail: If available, start TCP. Set rate 60-80 bpm. Increase mA until capture. Verify mechanical capture with pulse. Sedate if conscious (Fentanyl/Midazolam).; time: ; drugs:
- id: 5; title: Treat Reversible Causes; detail: Common causes: beta-blockers, calcium channel blockers, digoxin, hyperkalemia, hypothermia, inferior MI, increased ICP. Treat the underlying cause.; time: ; drugs:
Source and review
- AHA ACLS Guidelines 2020; Kusumoto et al., Circulation 2019. Last reviewed: 2024-11-01