Page 282 - PJ MED OPS Handbook 8th Ed

Adult ACLS Bradycardia
Adult Bradycardia Algorithm

Assess appropriateness for clinical condition.
Heart rate typically <50/min if bradyarrhythmia.

Identify and treat underlying cause
• Maintain patent airway; assist breathing as necessary
• Oxygen (if hypoxemic)
• Cardiac monitor to identify rhythm; monitor blood pressure and oximetry
• IV access
• 12-Lead ECG if available; don’t delay therapy
• Consider possible hypoxic and toxicologic causes
Persistent
bradyarrhythmia causing:
• Hypotension?
No
Monitor and observe • Acutely altered mental status?
• Signs of shock? Doses/Details
• Ischemic chest discomfort?
Atropine IV dose:
• Acute heart failure?
First dose: 1 mg bolus.
Repeat every 3-5 minutes.
Yes Maximum: 3 mg.
Dopamine IV infusion:
Usual infusion rate is
Atropine
5-20 mcg/kg per minute.
If atropine ineffective:
Titrate to patient response;
• Transcutaneous pacing
taper slowly.
and/or
Epinephrine IV infusion:
• Dopamine infusion
2-10 mcg per minute infusion.
or
Titrate to patient response.
• Epinephrine infusion
Causes:
• Myocardial ischemia/
infarction
• Drugs/toxicologic (eg,
calcium-channel blockers,
Consider: beta blockers, digoxin)
• Hypoxia
• Expert consultation
• Electrolyte abnormality
• Transvenous pacing (eg, hyperkalemia)
© 2020 American Heart Association

280 n Pararescue Medical Operations Handbook / 8th Edition