Version control: This document is current with respect to the latest 2016 American Heart Association® Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 21, 2020. If you are reading this page after October 21, 2020, please contact ACLS Training Center at for an updated document.

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  1. If the patient is stable, identify the cause of the bradycardia and treat it.
  2. Complete the basics
    1. Be sure that the airway is patent – do whatever is necessary to maintain a patent airway
    2. Administer oxygen as needed (02 Saturation less than 94% or the presence of shortness of breath)
    3. Apply cardiac monitor
    4. Take and monitor vital signs including pulse oximetry
    5. Obtain IV or IO access
    6. 12 Lead ECG – if available and patient stable (do not delay treatment to acquire)
  3. If signs of perfusion is present proceed with treatment
    1. Hypotension
    2. Acutely altered level of consciousness
    3. Signs of shock
  4. If no signs of perfusion
    1. Support basics (ABCs)
    2. Give oxygen if indicated
    3. Observe
    4. Consider cardiology consultation
  5. Signs of poor perfusion
    1. If HR <60/min with poor perfusion despite 02 and ventilation begin CPR
    2. Administer atropine (0.02mg/kg) if suspected vagal response or if primary AV block maximum single dose of 0.5mg
    3. Administer epinephrine 0.01mg/kg (0.1ml/kg) of 1:10,000 Can be repeated every 3–5 minutes if bradycardia does not resolve