BRADYCARDIA ALGORITHM
The Bradycardia Algorithm provides a structured approach to managing patients with bradycardia (slow heart rate). Bradycardia becomes clinically significant when it causes symptoms such as hypotension (low blood pressure), altered mental status, chest pain, or shortness of breath.
INITIAL ASSESSMENT
Assess the Patient: Evaluate the patient for signs and symptoms of hemodynamic instability (e.g., hypotension, altered mental status, signs of shock).
Monitor ECG and Blood Pressure: Continuously monitor the patient’s ECG and blood pressure.
IS THE BRADYCARDIA CAUSING SYMPTOMS?
The key decision point in the Bradycardia Algorithm is whether the bradycardia is causing significant symptoms.
SYMPTOMATIC BRADYCARDIA
If the bradycardia is causing symptoms:
Administer Atropine: Atropine is the first-line medication for symptomatic bradycardia. The recommended dose is 0.5 mg IV/IO. Atropine can be repeated every 3-5 minutes to a maximum total dose of 3 mg.
If Atropine Is Ineffective: If atropine is ineffective or if the patient has a second-degree type II heart block or third-degree heart block, consider the following:
Prepare for Transvenous Pacing: If the patient remains symptomatic despite these interventions, prepare for transvenous pacing (insertion of a pacing wire into a vein and advanced into the right ventricle).
ASYMPTOMATIC BRADYCARDIA
If the patient is bradycardic but not experiencing significant symptoms, generally no immediate treatment is required. However, the patient should be closely monitored for any changes in their condition.
POTENTIAL CAUSES OF BRADYCARDIA
It is important to identify and treat any underlying causes of the bradycardia. Potential causes include:
The Bradycardia Algorithm provides a systematic approach to managing patients with slow heart rates. Healthcare professionals should be familiar with this algorithm to ensure appropriate and timely intervention.