Adult Bradycardia With a Pulse Algorithm

This flowchart illustrates the Adult Bradycardia With a Pulse Algorithm. It consists of numbered boxes and a hexagon linked together with arrows, as well as an inset table at the bottom right. Box 1 at the top, which is orange, says, “Assess appropriateness for clinical condition. Heart rate typically less than 50 beats per minute if bradyarrhythmia.” An arrow points downward to box 2, which is green and titled “Identify and treat underlying cause.” It contains several points of text:
  • Maintain patent airway; assist breathing as necessary.
  • Oxygen (if hypoxemic).
  • Cardiac monitor to identify rhythm; monitor blood pressure and oximetry.
  • I.V. access.
  • 12-Lead ECG if available; don’t delay therapy.
An arrow leads down to a red hexagon for an assessment. It asks “Persistent bradyarrhythmia causing:
  • Hypotension?
  • Acutely altered mental status?
  • Signs of shock?
  • Ischemic chest discomfort?
  • Acute heart failure?
If the answer is “No,” an arrow points to the left to box 4. This green box says, “Monitor and observe.” If the answer is “Yes,” an arrow leads down to box 5. This green box is titled “Atropine.” It says: “If atropine is ineffective:
  • Transcutaneous pacing or
  • Dopamine infusion or
  • Epinephrine infusion.
From here, an arrow points to box 6. This green box says, “Consider expert consultation [and] transvenous pacing.” The inset table is titled “Doses or Details.” It has three main topics. The first is “Atropine IV dose.” Accompanying text states: “First dose: 0.5 milligram bolus. Repeat every 3 to 5 minutes. Maximum: 3 milligrams.” The second topic is “Dopamine IV infusion.” Its related text says, “Usual infusion rate is 2 to 20 micrograms per kilogram per minute. Titrate to patient response; taper slowly.” The final topic is “Epinephrine IV infusion.” It includes the following text: “2 to 10 micrograms per minute infusion. Titrate to patient response.” This figure is copyright 2015 by the American Heart Association.