Bradycardia With A Pulse Algorithm

Management of Persistent Bradycardia

This algorithm provides a detailed approach for the evaluation and management of patients presenting with persistent bradycardia, typically characterized by a heart rate of less than 50 beats per minute. It emphasizes the identification of underlying causes, immediate stabilization, and specific treatments to address symptomatic bradyarrhythmias.

Initial Assessment and Stabilization

Maintain Patent Airway: Ensure that the patient’s airway is open. Assist with breathing as necessary.

Oxygen Administration: Provide oxygen if the patient is hypoxemic to maintain adequate oxygen saturation.

Cardiac Monitoring: Place the patient on continuous cardiac monitoring to identify the rhythm, and monitor blood pressure and oximetry.

Obtain 12-Lead ECG: Perform an ECG to assess the electrical activity of the heart and identify specific types of bradycardia.

Establish IV Access: Prepare for potential administration of medications by establishing intravenous access early in the assessment.

Identify and Treat Underlying Causes

Consider Possible Hypoxic & Toxicologic Causes: Evaluate for conditions that might be contributing to the bradycardia such as hypoxia or the influence of toxic substances or medications.

Assessment of Symptoms: Determine if the bradycardia is causing significant clinical symptoms such as hypotension, acute altered mental status (AMS), signs of shock, ischemic heart discomfort, or acute heart failure.

Treatment Decisions Based on Symptom Severity

Mild to Moderate Symptoms:

Atropine Administration: If there are no contraindications, administer 1 mg of atropine IV. This can be repeated every 3-5 minutes to a maximum dose of 3 mg.

Severe Symptoms or Ineffective Atropine:

Transcutaneous Pacing: Initiate transcutaneous pacing if available and indicated, especially if atropine is ineffective.

Dopamine Infusion: Start a dopamine infusion at 2-10 mcg/kg/min. Adjust the rate based on patient response and taper slowly as conditions improve.

Epinephrine Infusion: Administer an epinephrine infusion at 2-10 mcg/min. Titrate the infusion according to patient response, monitoring for effectiveness and potential side effects.

Advanced Interventions

Consultation with Expert: If the initial management is ineffective or if the patient’s condition is deteriorating, consult a cardiologist or a specialist in emergency medicine for advice on further management, including the possibility of transvenous pacing.

Monitoring and Adjustments

Continuous Monitoring: Throughout the treatment, continuously monitor the patient’s cardiac rhythm, hemodynamic status, and overall clinical response to interventions. Adjust treatments as needed based on ongoing assessments and expert recommendations.