Cardiac arrest and ACLS

Bradycardia With a Pulse Algorithm

Symptomatic bradycardia, step by step

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

Each step lists what to do, then the choices that lead on. In the app the algorithm is tapped through one decision at a time.

1 Heart rate under 50 and causing symptoms?

Airway, oxygen if hypoxemic, monitor, IV, 12-lead ECG
Look for hypotension, altered mental status, shock, chest pain, acute heart failure

Yes: signs of poor perfusion → step 2 No: stable → step 3

2 Atropine

1 mg IV, repeat every 3–5 minutes, up to 3 mg total
May not work after heart transplant or in high-grade infranodal block

Not effective → step 4 Effective → step 3

3 Monitor and find the cause

Medications (beta-blockers, calcium channel blockers, digoxin), high potassium, ischemia, hypothermia, raised ICP
Have pacing ready if it is high-grade AV block

End of this path.

4 Pacing or a drip

Transcutaneous pacing (sedate and analgesia), or
Dopamine 5–20 mcg/kg/min, or
Epinephrine 2–10 mcg/min
Expert consultation; transvenous pacing

End of this path.

Drugs in this algorithm

Practice free in your browser2,450+ exam-style questions with rationales. No account, no ads. Also free on the App Store and Google Play.

For education and exam preparation only. Follow your institution’s protocols. Study aid with typical adult values; follow your local protocols and medical direction, and current AHA guidelines.