ACLS bradycardia algorithm: Assessments and actions

Symptomatic bradycardia, heart rate typically <60 beats per minute with presence of symptoms, is identified and treated directed at the underlying cause.

Initial management: 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 1 mg IV every 3 to 5 minutes (maximum total dose: 3 mg)
• 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