Bradycardia: diagnosis and treatment updates

Diagnosisbook supporting video - Bradycardia symptoms, causes, diagnosis, and treatment

Bradycardia in adults

Initial treatment

General patient care.

If the patient has symptoms (such as altered mental status or ischemia).

Atropine Sulphate 0.5 mg IV every three (3) to five (5) minutes up to a total dose of 3 mg may be given pending pacemaker establishment.

Indications for further treatment

Additional doses of the above drugs.

Intravenous Norepinephrine: 0.1mcg/kg/min via the pump, titrated to target systolic blood pressure 90mmHg, or;

Dopamine 2-20 mcg/kg/min intravenously.

Infusion of epinephrine 1-10 mcg/min intravenously.

For example, mix 1mg of Epinephrine 1:1000 in 250mL of regular saline, (15 micro drops/min = 1mcg/min).

Bradycardia in children

Initial treatment

General patient care.

If the pulse is less than 60 in children and patients have severe symptoms, consider starting

Cardiopulmonary resuscitation (CPR).

Indications for further treatment

If the patient has severe symptoms:

Epinephrine 1: 10,000, 0.01 mg/kg IV or bolus (maximum dose 0.5 mg) or,

Atropine 0.02 mg/kg IV (minimum dose 0.1 mg, maximum dose 1 mg).

If vagal hypertonia or atrioventricular block is suspected:

Additional doses of the above drugs.

Add fluid (10-20mL/kg).

Epinephrine 1: 10,000 - 0.01-0.03 mg/kg IV (maximum 0.5 mg single dose).

Epinephrine infusion 1: 1,000, 0.1-1 mcg/kg/min intravenously.

For example, mix 1mg of Epinephrine 1:1000 in 250mL of regular saline, (15 micro drops/min = 1 mcg/min.)

Attention

The bradycardia that causes symptoms is usually <50/min. Cardiac rhythm should be interpreted in the context of symptoms and drug therapy indicated only when symptomatic, otherwise monitoring and revaluation.

Recognizing the signs and symptoms of bradycardia-induced hypoperfusion is paramount.

Do not delay pacing while awaiting placement of an intravenous line.

Without delay transport immediately to the hospital

Hypoxemia is a common cause of bradycardia; Ensure oxygen supply to the patient and assist with mechanical ventilation when necessary.

Related articles:

Lecture of bradycardia

Bradycardia