ACLS Bradycardia Algorithm
| Potential Cause | How to Identify | Treatments |
| Hypovolemia | Rapid heart rate and narrow QRS on ECG; ... | Infusion of normal saline or Ringer’s la ... |
| Hypoxia | Slow heart rate | Airway management and effective oxygenat ... |
| Hydrogen Ion Excess (Acidosis) | Low amplitude QRS on the ECG | Hyperventilation; consider sodium bicarb ... |
| Hypoglycemia | Bedside glucose testing | IV bolus of dextrose |
Full Answer
When does bradycardia need treatment?
Treatment for bradycardia depends on the type of electrical conduction problem, the severity of symptoms and the cause of your slow heart rate. If you have no symptoms, treatment might not be necessary. If a disorder such as hypothyroidism or obstructive sleep apnea is causing bradycardia, treatment of the disorder might correct bradycardia.
How much atropine do you give for bradycardia?
The recommended atropine dose for bradycardia is 0.5 mg IV every 3 to 5 minutes to a maximum total dose of 3 mg. People also ask, how do you give atropine to bradycardia? 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.
What is the most common bradycardia treatment?
- Injury to the heart due to heart attack, endocarditis or a medical procedure
- Inflammation of the heart muscle
- Low thyroid function
- Electrolyte imbalance in the blood
- Sleep apnea
- Congenital heart defect
- Valvular heart disease
- Lyme disease
When to give atropine ACLS?
- Antisialagogue/anti-vagal: 0.5 mg to 1 mg every 1 to 2 hours
- Organophosphate or muscarinic poisoning: 2 mg to 3 mg every 20 to 30 minutes (may require doses up to 20 mg, titrate to effect for secretion control)
- Bradycardia: 1 mg every 3 to 5 minutes (3 mg max), repeat until obtaining desired heart rate, most effective for sinus and AV nodal disease.
When should bradycardia be treated?
Treatment for bradycardia depends on the severity of symptoms and the cause of the slow heart rate. If you don't have symptoms, treatment might not be necessary. Bradycardia treatment may include lifestyle changes, medication changes or an implanted device called a pacemaker.
When a patient has symptomatic bradycardia what drug should be used?
The American Heart Association recommends atropine sulfate as the first line of treatment for symptomatic bradycardia, regardless of whether it is due to AVB or not. This is where the nuance of complete heart blocks comes in.
What is the criteria for bradycardia?
Key Updates for Patients In the past, anything fewer than 60 beats per minute has been considered slower than normal. The new guidelines say sinus node dysfunction includes a heart rate less than 50 beats per minute, or at least a 3-second pause in between heartbeats — or both.
What is considered severe bradycardia?
If you have bradycardia, your heart beats fewer than 60 times a minute. Bradycardia can be a serious problem if the heart rate is very slow and the heart can't pump enough oxygen-rich blood to the body. If this happens, you may feel dizzy, very tired or weak, and short of breath.
At what heart rate do you give atropine?
Atropine is the first-line therapy (Class IIa) for symptomatic bradycardia in the absence of reversible causes. Treatments for bradydysrhythmias are indicated when there is a structural disease of the infra-nodal system or if the heart rate is less than 50 beats/min with unstable vital signs.
When does bradycardia require a pacemaker?
Your doctor may recommend a temporary pacemaker when you have a slow heartbeat (bradycardia) after a heart attack, surgery or medication overdose but your heartbeat is otherwise expected to recover. A pacemaker may be implanted permanently to correct a chronic slow or irregular heartbeat or to help treat heart failure.
Is bradycardia an emergency?
Asymptomatic bradycardia generally does not require any emergency treatment.
What are the two types of bradycardia?
There are two main types of bradyarrhythmia: sinus node dysfunction and atrioventricular (AV) blocks....The AV node can become blocked in a few different ways:First degree heart block. ... Second degree heart block. ... Third degree heart block.
What heart rate is too low on beta blockers?
Bradycardia with associated hypotension and shock (systolic BP < 80 mm Hg, heart rate < 60 bpm) defines severe beta-blocker toxicity.
At what heart rate should you go to the hospital?
If you're sitting down and feeling calm, your heart shouldn't beat more than about 100 times per minute. A heartbeat that's faster than this, also called tachycardia, is a reason to come to the emergency department and get checked out. We often see patients whose hearts are beating 160 beats per minute or more.
What is the best treatment for bradycardia?
The standard treatment for a slow heart rate is to implant a pacemaker. For people with bradycardia, this small device can help restore a normal heartbeat.
How to treat bradycardia?
A bradycardic rhythm is most often treated only when symptoms are present. If reversible causes aren’t immediately identified and/or if reversing the cause is taking too long, pharmacologic interventions are the first-line approach for bradycardia treatment. Atropine 0.5 mg intravenous (IV) is given up to a total of 3 mg. 1 Atropine sulfate acts by reversing the cholinergic-mediated decreases in the heart rate and AV node conduction. 1
What are the symptoms of bradycardia?
5. Common bradycardia symptoms include: syncope. presyncope. transient dizziness or lightheadedness. fatigue. dyspnea on exertion. heart failure symptoms.
What is bradycardia heart rate?
What is bradycardia? The National Institutes of Health defines bradycardia* as a heart rate <60 bpm in adults other than well-trained athletes. 9 The determination on whether or not treatment is necessary for bradycardic events is generally based on the presence of bradycardia symptoms. The clinical manifestations of bradycardia can vary widely from insidious symptoms to episodes of frank syncope. 5
What percentage of patients with sleep apnea have sinus bradycardia?
The prevalence of sinus bradycardia in patients with sleep apnea can be as high as 40%, with episodes of second- or third-degree AV block in up to 13% of patients. 8
What is the best treatment for atropine ineffective?
If atropine is ineffective, two treatment pathways are available. The patient’s heart can be paced either intravenously or transcutaneously (TCP), or more emergency medicine can be given. The two pharmacologic choices are dopamine 2 to 20 mcg/kg/min and/or epinephrine 2 to 10 mcg/min. 1
When a patient is evaluated for symptomatic bradycardia, an in-depth history and physical is?
When a patient is evaluated for symptomatic bradycardia, an in-depth history and physical is important, along with the identification of possible reversible causes. The following is a list of conditions associated with bradycardia and conduction disorders: 11
Can exercise be used to diagnose ischemia?
Exercise Testing. Although not routinely recommended for assessment of ischemia, exercise testing can be considered in patients with symptoms temporally related to exercise, asymptomatic second-degree AV block, or for suspected chronotropic incompetence. 11.
