Bradycardia (Adult)

Assess

Perfusion Status

Stable • Asymptomatic • Adequate Perfusion • HR >20 BLS If Pt deteriorates: - Mx as per Unstable if patient deteriorates			Unstable • Less than adequate perfusion   - including acute STEMI and ischemic chest pain • Profound bradycardia (HR <40) and full field APO • Runs of VT or ventricular escape rhythms • HR <20 Atropine 600mcg IV If no response after 3 to 5 minutes:   - Repeat Atropine 600mcg IV
			If Inadequate or Extremely Poor Perfusion persists Adrenaline Infusion (3mg/50ml Dextrose 5% / Normal Saline) commencing at 5mcg/min. (5ml/hr) - Increase by 5mcg/min, 2 minutely until adequate perfusion/side effects (max 20mcg/min) - If syringe pump unavailable/malfunction: - Adrenaline 10mcg IV - repeat 10mcg IV, 2 minutely until adequate perfusion / side effects
			Is Adequate Perfusion Achieved?
			Yes					No
			Continue current Mx Transport				Treat as per Inadequate Perfusion - Cardiogenic Causes

Special Notes

• Atropine is unlikely to be effective in complete heart block.

• If side effects occur during Adrenaline Infusion, cease infusion and recommence once side effects resolve titrating to Pt response.

• If no increase in HR, pacing is likely to be required.

• Notify appropriate hospital capable of managing a Pt likely to require pacing.

General Care

• Adrenaline Infusion - 3mg Adrenaline added to make 50ml with Dextrose 5% or Normal Saline. - 1ml/hr = 1mcg/min

• If no response from Adrenaline Infusion at 20mcg/min., increasing infusion rate is unlikely to have additional chronotropic effects.