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ACLS.net ACLS 2005 Bradycardia Algorithm

The following mnemonic directs AHA accepted actions after absolute (<60bpm) or relative (slower rate than expected) bradycardia with circulatory compromise due to the slow rate is discovered. Start the Secondary ABCDs and remember:

*Pacing Always Ends Danger

Mnemonic Intervention Note
Pacing **TCP Immediately prepare for transcutaneous pacing (TCP) with serious circulatory compromise due to bradycardia (especially high-degree blocks) or if atopine failed to increase rate.
Consider medications while pacing is readied.
Always Atropine 1st-line drug, 0.5 mg IV/IO q3-5 min. (max. 3mg)
Ends Epinephrine
2-10 µg/min		 2nd-line drugs to consider if atropine and/or TCP are ineffective. Use with extreme caution.
Danger Dopamine
2-10 µg/kg/min


*Pacing does not "always end danger" in bradyarrhythmias. If the above measures do not improve circulatory stability the bradycardia may merely be an indication of a pathological process, think Differential Diagnosis!
**Prepare for transvenous pacing (TVP), managed by an expert, if TCP fails.

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