Adult Bradycardia Algorithm (ACLS)
A clear, modern walkthrough of symptomatic bradyarrhythmia: initial stabilization, rhythm monitoring, atropine, dopamine/epinephrine infusions, and pacing—plus common reversible causes to check every time.
Educational content only—use current guidelines and local protocols; consult a licensed clinician.
1) Initial Assessment
- Confirm heart rate (often < 50/min) and assess clinical appropriateness for the condition.
- Support airway and breathing; give oxygen if hypoxemic.
- Cardiac monitor: identify rhythm; monitor blood pressure and oximetry.
- Gain IV access; obtain a 12-lead ECG if available (do not delay treatment).
2) Identify & Treat the Underlying Cause
Rule out and correct triggers while preparing for symptomatic treatment.
- Ensure patent airway; assist ventilation as needed.
- Review meds/toxins (e.g., calcium-channel blockers, beta-blockers, digoxin).
- Consider myocardial ischemia, hypoxia, and electrolyte abnormalities (e.g., hyperkalemia).
3) Is the Bradycardia Symptomatic?
Look for any of the following “red flags” due to bradyarrhythmia:
- Hypotension
- Acutely altered mental status
- Signs of shock
- Ischemic chest discomfort
- Acute heart failure
If no red flags ➜ monitor and observe. If yes ➜ proceed with therapy below.
4) First-Line & Alternative Therapy
Atropine (IV)
- First dose: 1 mg IV bolus.
- Repeat every 3–5 minutes as needed.
- Maximum total dose: 3 mg.
If Atropine Ineffective
- Begin transcutaneous pacing (TCP) and/or
- Dopamine infusion: typical range 5–20 mcg/kg/min, titrate to response.
- Epinephrine infusion: typical range 2–10 mcg/min, titrate to response.
Choose infusions and pacing per local protocols, patient physiology, and expert input.
5) Pacing & Expert Consultation
- Start TCP for unstable patients unresponsive to atropine.
- Consider transvenous pacing and expert consultation if instability persists.
Common Reversible Causes
Cardiac
- Myocardial ischemia/infarction
- Conduction system disease
Drugs/Toxicologic
- Calcium-channel blockers
- Beta-blockers
- Digoxin
Metabolic/Other
- Hypoxia
- Electrolyte abnormality (e.g., hyperkalemia)
- Hypothermia
Cited Keywords & Referral Links
Each keyword links to the main site or a related post on gyathshammha.com.
Bottom line
Stabilize, identify the cause, and treat symptomatic bradycardia with atropine first—then pacing or vasoactive infusions as needed, while addressing reversible triggers. Reassess frequently and consult experts early when instability persists.
This guide summarizes common teaching points and is not a substitute for current clinical guidelines or medical advice.