bradycardia algorithm

7/28/2019 Bradycardia Algorithm

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Bradycardia AlgorithmGrou III



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Bradycardia Algorithm

• The ACLS Bradycardia Algorithm outlines the

steps for assessing and managing a patient

who presents with symptomatic bradycardia.• It begins with the decision that the patient’s

heart rate ( < 60 bpm) is too slow to be

physiologically appropriate for the person.



STEPS



Step 1

Decision point: Heart rate is < 60 bpm and is

inadequate for patient’s clinical condition.



Step 2

Assess and manage the patient using theprimary and secondary surveys.



Step 2 (cont.)

– Maintain patent AIRWAY; assist BREATHING as needed

– Give oxygen

– Monitor ECG (identify rhythm), blood pressure, oximetry

– Establish IV access

– Take a problem-focused history and physical exam.

– Search for and treat possible contributing factors.



Step 2 (cont.)

Primary survey:

A = Airway → Check airway patency

B = Breathing → Check if breathing adequately C = Circulation → Check pulse and bleeding

D = Disability → Neurological status [A]lert

[V]oice responsive

[P]ain responsive

[U]nresponsive



Step 2 (cont.)

Secondary survey:

E = Expose → Check for obvious external trauma

F = Fahrenheit → Check temperature

G = Get vitals → Pulse, Respiration, Skin signs, Pupils and BP H = History → Present, related and past history

[S]igns and symptoms

[A]llergies

[M]edications

[P]revious medical history

[L]ast oral intake

[E]vents leading to the injury



Step 3

Answer two questions to help you decide if the patient’s

signs and symptoms of poor perfusion are caused by thebradycardia.



Step 3 (cont.)

1. Are the signs or symptoms serious?

(e.g. hypotension, pulmonary congestion,

dizziness, shock, ongoing chest pain, shortness of breath, congestive heart failure, weakness or

fatigue, and acute altered mental status)

2. Are the signs and symptoms related to the slow

heart rate?



Step 4

Decide whether the patient has adequate or poor

perfusion, since the treatment sequence is determined bythe severity of the patient’s clinical presentation.



Step 4 (cont.)

If perfusion is adequate, monitor and observe the patient.



Step 4 (cont.)

If perfusion is poor, move quickly through the following

steps:

i. Prepare for transcutanous pacing. Do not delay pacing if high

degree block (2° AVB Type II and 3° AVB).ii. Consider administering atropine 0.5 mg IV during the interval

before pacing starts. Repeat as needed every 3 to 5 minutes

up to 3 doses.

iii. If the atropine is ineffective, begin pacing.iv. Consider epinephrine (2-10 µg/min) or dopamine (2-10

µg/kg/min) while waiting for the pace or if pacing is

ineffective



Step 5

Prepare for transvenous pacing.

Treat contributing causes.

Consider expert consultation.



TAKE NOTE!

Progress quickly through these actions as the patient

could be in pre-cardiac arrest and need multipleinterventions done in rapid succession: pacing, IV

atropine, and infusion of dopamine or epinephrine.



Medications

1. Atropine → most effective for narrow-QRS bradycardias

2. Dopamine

3. Epinephrine



Narrow-QRS Bradycardias



Wide-QRS Bradycardias



Source

http://www.acls.net/acls-bradycardia-algorithm.htm

bradycardia algorithm

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