THE BRADYCARDIA

ALGORITHM
Sinus bradycardia • Sinus tachycardia  Asystole
 Pulseless VT
Sinus pause • Supraventricular
 Ventricular
tachycardia
Escape rhythms: fibrillation
Junctional rhythm • Atrial fibrillation  Pulseless
electrical
Idioventricular
rhythm • Atrial flutter activity

Heart blocks • Multifocal atrial

tachycardia

• Ventricular
tachycardia
General ACLS Algorithm:
Step-by-step when you think
rhythm is abnormal

RHYTHM

PULSE

With Pulse Pulseless

B.P. ARREST

STABLE UNSTABLE
CPR
Bradycardia ACLS
Algorithm
RHYTHM

PULSE
With Pulse Pulseless
B.P. ARREST PEA

STABLE UNSTABLE
CPR

OBSERVE ELECTRICAL THERAPY

(Pacing)
MEDICATIONS
BRADYCARDIA with Pulse
2 questions

1. Is the patient hemodynamically

stable?

2. Is a transcutaneous pacemaker
available?
 Bradycardia
Check BP, sensorium
Stable  Observe
Unstable  T-A-E-D
Transcutaneous Pacing (TCP) – Atropine –
Epinephrine drip – Dopamine drip
 Bradycardia Algorithm

Case

67-year-old

Lightheadedness and
history of syncope 2
months ago

Currently asymptomatic

BP of 100/60, HR 40
 Bradycardia Algorithm

What is the rhythm and what is the next best step?

5…….4……3……2……1…….0
 Bradycardia Algorithm

Next step?

a. transcutaneous pacing
b. atropine
c. epinephrine
d. dopamine
e. observe and monitor

5…….4……3……2……1…….0
 Bradycardia Algorithm
After several minutes,
BP dropped to 80/40 mm Hg
Patient more lethargic
Identify the rhythm!

3rd degree or complete heart block

5…….4……3……2……1…….0
 Bradycardia Algorithm

Management:
a. transcutaneous pacing
b. atropine
c. epinephrine
d. dopamine
e. observe and monitor

5…….4……3……2……1…….0