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What is Bradycardia

Absolute bradycardia is defined as a pulse rate less than 60 bpm. During the patient assessment, it should be determined whether bradycardia-induced life-threatening signs and symptoms are present.

Signs and Symptoms of Bradycardia

Bradycardia can present itself in several different cardiac rhythms, including sinus bradycardia and varying degrees of atrioventricular heart blocks. Regardless of the rhythm, if the heart rate is too slow, and the patient has symptoms from the slow rate, then the bradycardia should be treated to increase the heart rate and improve perfusion. For a patient that is asymptomatic, care should be continued with close monitoring.

Bradycardia Treatment

The primary treatment for symptomatic bradycardia includes the following:

  • Administration of supplemental oxygen if pulse oximetry is below 94%.
  • Establishment of IV access
  • Monitoring of the ECG rhythm.  A 12-lead ECG should be maintained as soon as possible without delaying therapies
  • Administration of atropine at 0.5 mg via rapid IV push to increase the heart rate. If serious signs and symptoms are present, such as unresponsiveness, start transcutaneous pacing immediately instead of giving atropine.

If Atropine is ineffective:

  • Transcutaneous pacing should be started. With conscious patients who need transcutaneous pacing, sedation may help alleviate the discomfort.
  • Other medications should be considered: an Epinephrine infusion at 2-10 mcg/min or a Dopamine infusion at 5-10 mcg/kg/min.

Some patients may present with relative bradycardia. This is when the heart rate is over 60, but the patient presents with low blood pressure or a decreased level of consciousness. These patients need the same interventions as patients with absolute bradycardia.

Adult Bradycardia With a Pulse Algorithm

Adult Bradycardia with a Pulse Algorithm