Advanced Cardiovascular Life Support Algorithms

Adult Bradycardia With a Pulse Algorithm: Step by Step

1. 1

   Assess the heart rate

   Determine whether the heart rate is appropriate for the patient’s condition. Bradyarrhythmia typically involves a heart rate <50/min.

2. 2

   Is there cardiopulmonary compromise?

   Signs may include low blood pressure (hypotension), ischemic chest discomfort, signs of shock, acute change in mental status, and acute heart failure.

   • Yes: provide assessment and support
   • No: treat and monitor
3. 3

   Compromise present: assessment and support

   Then check whether bradycardia persists with cardiopulmonary compromise.

   • Keep the airway open and administer oxygen
   • Support breathing with positive-pressure ventilation as needed
   • Connect the patient to a cardiorespiratory monitor
   • Continue monitoring the pulse
4. 4

   No compromise: treat and monitor

   • Identify and treat potential causes
   • Support airway, breathing, and circulation
   • Consider supplemental oxygen
   • Obtain a 12-lead ECG
   • Continue monitoring the patient
5. 5

   Does bradycardia persist with cardiopulmonary compromise?

   • No: treat and monitor
   • Yes: administer atropine
6. 6

   Administer atropine

   If atropine is ineffective, use transcutaneous pacing and/or a dopamine or epinephrine infusion.

7. 7

   Next steps

   • Consider expert consultation
   • Assess the need for transvenous pacing