Cardiac arrest and ACLS

Bradycardia With a Pulse Algorithm

Symptomatic bradycardia, step by step

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

Each step lists what to do, then the choices that lead on. In the app the algorithm is tapped through one decision at a time.

1 Heart rate under 50 and causing symptoms?

Airway, oxygen if hypoxemic, monitor, IV, 12-lead ECG
Look for hypotension, altered mental status, shock, chest pain, acute heart failure

Yes: signs of poor perfusion → step 2 No: stable → step 3

2 Atropine

1 mg IV, repeat every 3–5 minutes, up to 3 mg total
May not work after heart transplant or in high-grade infranodal block

Not effective → step 4 Effective → step 3

3 Monitor and find the cause

Medications (beta-blockers, calcium channel blockers, digoxin), high potassium, ischemia, hypothermia, raised ICP
Have pacing ready if it is high-grade AV block

End of this path.

4 Pacing or a drip

Transcutaneous pacing (sedate and analgesia), or
Dopamine 5–20 mcg/kg/min, or
Epinephrine 2–10 mcg/min
Expert consultation; transvenous pacing

End of this path.

Drugs in this algorithm

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For education and exam preparation only. Follow your institution’s protocols. Study aid with typical adult values; follow your institution's protocols and current AHA guidelines.