Diferencia entre revisiones de «ACLS: bradycardia»

Revisión actual - 10:03 22 mar 2026

This page is for bradycardia with a pulse; for bradycardia without a pulse (i.e. PEA) see Adult pulseless arrest

Heart rate < 60
Intervention indicated if patient is symptomatic or experiencing symptoms of end organ damage (chest pain, altered mental status, shortness of breath, hypotension)

Cardiac
- Inferior MI (involving RCA)
- Sick sinus syndrome
Neurocardiogenic/reflex-mediated
- Increased ICP
- Vasovagal reflex
- Hypersensitive carotid sinus syndrome
- Intra-abdominal hemorrhage (i.e. ruptured ectopic)
Metabolic/endocrine/environmental
- Hyperkalemia
- Hypothermia (Osborn waves on ECG)
- Hypothyroidism
  - Myxedema coma
- Hypoglycemia (neonates)
Toxicologic
Infectious/Postinfectious
Other
- Brash syndrome

Algorithm for bradycardia with a pulse (Adapted from ACLS 2010)

Atropine
- Can be used as temporizing measure (while awaiting pacing and/or chronotropes)
- Use cautiously in patients with ongoing ischemia (tachycardia may worsen ischemia)
- Avoid and/or do not rely on in wide complex bradycardia, especially in setting of ischemia^[1]
- 1 mg q3-5 min IV (max 3 mg)
  - May not work in 2nd/3rd degree heart block, heart transplant
  - Priority is to use external cardiac pacemaking^[2]
  - Block is below AV node so atropine will accelerate sinus rate, leading to worsening of block and increased fatigue of AV nodal cells
Chronotropes
- Dopamine 5-20 mcg/kg/min IV drip
- Dobutamine 2-20 mcg/kg/min IV drip
- Epinephrine 2-10 mcg/min (0.03-0.2 mcg/kg/min) IV drip
- Isoproterenol 2-10 mcg/min IV drip
Transcutaneous Pacing
Transvenous Pacing

Beta-Blocker Toxicity
- Glucagon 5 mg q10 min (up to 3 doses) IV
- Insulin 1 U/kg bolus IV
- Intralipid (ILE)
Calcium Channel Blocker Toxicity
- Calcium gluconate 3 g IV
- Insulin 1 U/kg bolus IV
- Intralipid (ILE)
Digoxin Toxicity
- Dig immune Fab 10-20 vials IV
Opioid Toxicity
- Naloxone 0.4 mg IV
Organophosphate Toxicity
- Atropine 2 mg, double q5-30 min until secretions controlled IV
- Pralidoxime 1-2 g over 15-30 min IV

Admit to telemetry/ICU for:
- Symptomatic bradycardia requiring pharmacologic or pacing intervention
- High-degree AV block (second-degree type II, third-degree)
- Bradycardia with hemodynamic instability
- New-onset bradycardia of unclear etiology
Cardiology consultation for all patients requiring temporary pacing
Discharge with outpatient cardiology follow-up for:
- Asymptomatic sinus bradycardia with rate >50 in young/athletic patients
- Known stable bradycardia at baseline

↑ Neumar RW et al. Part 8: Adult Advanced Cardiovascular Life Support. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
↑ Burns, E. AV block: 3rd degree (complete heart block). http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/

Authors:

@@ Línea 54: / Línea 54: @@
 **{{MedicationDose|drug=Atropine|dose=2 mg, double q5-30 min until secretions controlled|route=IV|context=Organophosphate toxicity|indication=ACLS: Bradycardia|population=Adult}}
 **{{MedicationDose|drug=Pralidoxime|dose=1-2 g over 15-30 min|route=IV|context=Organophosphate toxicity|indication=ACLS: Bradycardia|population=Adult}}
+==Disposition==
+*Admit to telemetry/ICU for:
+**Symptomatic bradycardia requiring pharmacologic or pacing intervention
+**High-degree AV block (second-degree type II, third-degree)
+**Bradycardia with hemodynamic instability
+**New-onset bradycardia of unclear etiology
+*Cardiology consultation for all patients requiring temporary pacing
+*Discharge with outpatient cardiology follow-up for:
+**Asymptomatic sinus bradycardia with rate >50 in young/athletic patients
+**Known stable bradycardia at baseline
 ==See Also==