ACLS bradycardia algorithm: Assessments and actions

Last updated: June 27, 2023

Version control: Our ACLS, PALS & BLS courses follow 2020 American Heart Association Guidelines for CPR and ECC. American Heart Association guidelines are updated every five years. If you are reading this page after December 2025, please contact for an update. Version 2021.01.c

Symptomatic bradycardia, heart rate typically <50 beats per minute with presence of symptoms, is identified and treated directed at the underlying cause. Maintain a patent airway with assisted breathing as necessary. Administer supplemental oxygen if hypoxic. Place the patient on continuous cardiac monitoring to identify rhythm along with frequent monitoring of blood pressure and oxygen saturation. Obtain IV access and a 12 lead ECG. If the patient is hemodynamically stable monitor and observe. If the patient is presenting with hypotension, acute altered mental status, signs of shock, ischemic chest discomfort or signs of acute heart failure administer Atropine IV at the dose of 1 mg every 3 to 5 minutes. Do not administer more than 3 mg total. If Atropine is not effective consider transcutaneous pacing and/or Dopamine IV infusion 5 to 20 mcg/kg per minute or Epinephrine 2–10 mcg per minute. Consider expert consultation and transvenous pacing.

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This page was written by on Jul 1, 2021.