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Writer's pictureThe Resuscitation Coach
Sep 18, 20212 min read

ACLS Bradycardia Algorithm Review

Updated: Oct 18, 2021


The American Heart Association ACLS Bradycardia Algorithm is an important algorithm for the management of Symptomatic Bradycardia:


What should we do???🤔


A. Airway- Speak to the patient. If the patient is talking, their Airway is open. If patient is not responding immediately follow your BLS steps.

B. Breathing- Rate & Saturation~ Sats below 94%, start O2

C. Pulse & BP- ECG, Identify, IV & Meds.

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Are there serious signs & symptoms? Due to the Bradycardia?? 😬

🚨 Decrease Level of consciousness

🚨 Hypotension

🚨 Ischemic chest discomfort

🚨 Acute heart failure

🚨 Signs of shock

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Intervention sequence:


💉 Atropine 1mg every 3-5 minutes. Max 3 mg

⚡️ Transcutaneous Pacing (TCP)

💉 Dopamine 5-20 mcg/kg/min

💉 Epinephrine 2-10 mcg/min

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💡High degree blocks like Second Degree Block Type Two/ Mobitz 2 and Complete Heart block will not respond to Atropine.

💡 Prior to the use of ACLS drugs in the treatment of symptomatic bradycardia, contributing factors of the bradycardia should be explored then ruled out or corrected.

💡 If bradycardia is unresponsive to Atropine, an equally effective alternative to transcutaneous pacing is the use of an IV infusion of Beta-Adrenergic agonists (Dopamine or Epinephrine)

💡 TCP is more readily available and usually quicker & easier to deploy versus preparation of Dopamine & Epinephrine infusions in emergency situations.

💡 The goal of therapy is to improve the patient’s clinical status rather than target an exact heart rate.


AHA 2020 Guidelines: https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines


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