ACLS Bradycardia Algorithm
Treatment for bradycardia should be based on controlling the symptoms and identifying the cause using the H’s and T’s.
- Do not delay treatment but look for underlying causes of the bradycardia using the H’s and T’s
- Maintain the airway and monitor cardiac rhythm, blood pressure and oxygen saturation.
- Insert an IV or IO for medications.
- If the patient is stable, call for consults.
- If the patient is symptomatic, administer an atropine 0.5 mg IV or IO bolus; Repeat the atropine every 3-5 minutes to a total dose of 3 mg.
- If atropine does not relieve the bradycardia, continue evaluating the patient to determine the underlying cause and consider transcutaneous pacing.
- Consider an IV/IO dopamine infusion at 2-10 mcg/kg/minute
- Consider an IV/IO epinephrine infusion at 2-10 mcg/minute
The H’s and T’s of Bradycardia
How to Identify
|Hypovolemia||Rapid heart rate and narrow QRS on ECG; other symptoms of low volume||Infusion of normal saline or Ringer’s lactate|
|Hypoxia||Slow heart rate||Airway management and effective oxygenation|
|Hydrogen Ion Excess (Acidosis)||Low amplitude QRS on the ECG||Hyperventilation; consider sodium bicarbonate bolus|
|Hypoglycemia||Bedside glucose testing||IV bolus of dextrose|
|Hypokalemia||Flat T waves and appearance of a U wave on the ECG||IV Magnesium infusion|
|Hyperkalemia||Peaked T waves and wide QRS complex on the ECG||Consider calcium chloride, sodium bicarbonate, and an insulin and glucose protocol|
|Hypothermia||Typically preceded by exposure to a cold environment||Gradual rewarming|
|Tension Pneumothorax||Slow heart rate and narrow QRS complexes on the ECG; difficulty breathing||Thoracostomy or needle decompression|
|Tamponade – Cardiac||Rapid heart rate and narrow QRS complexes on the ECG||Pericardiocentesis|
|Toxins||Typically will be seen as a prolonged QT interval on the ECG; may see neurological symptoms||Based on the specific toxin|
|Thrombosis (pulmonary embolus)||Rapid heart rate with narrow QRS complexes on the ECG||Surgical embolectomy or administration of fibrinolytics|
|Thrombosis (myocardial infarction)||ECG will be abnormal based on the location of the infarction||Dependent on extent and age of MI|