BRADYCARDIA

Inclusion Criteria:  Patients with a heart rate less than 60 beats per minute.  These guidelines are not intended for patients with compensated bradycardia who exhibit signs of increased intracranial pressure (refer to STROKE or TRAUMA Guidelines).  Consider drug or other overdose, and refer to the ALTERED LOC Guidelines.

SPECIAL NOTE:  In young, generally healthy patients, bradycardia may result from hypoxia. DO NOT use these guidelines unless hypoxia has been treated or excluded from the differential diagnosis.

Basic Level

  1. Assess and support ABCs.
  2. Place the patient in a position of comfort.  If there is evidence of shock, place the patient supine with the feet elevated and closely monitor airway status.
  3. Administer oxygen, as needed, to maintain a SpO2 of at least 94%.
  4. If chest pain is present or develops, treat the pain under the CHEST PAIN Guidelines while continuing these guidelines.
  5. Once advanced level care arrives on scene, give report and transfer care.

Advanced Level

  1. Continuous ECG monitoring.  Use capnography if the patient is hypotensive.  Obtain a 12-Lead ECG and consult with BioTel, as needed.  (Do NOT delay care of the unstable patient to obtain a 12-lead ECG.)
  2. Establish IV/IO access at a TKO rate or use a saline lock.  (Do not delay care of the unstable patient to initiate vascular access.)

A. For Stable Patients

  1. Monitor vital signs, neurologic status, and ECG, and transport as soon as possible.
  2. For additional patient care considerations not covered under standing orders, consult BioTel.

B. For Unstable Patients (low BP, altered LOC, shock, chest pain, acute heart failure):

  1. If signs or symptoms of hypoperfusion are present or develop:

Adult

Begin transcutaneous pacing (TCP) immediately for 3rd-degree heart block.

Pediatric

Transcutaneous Pacemaker Guidelines - ADULTS ONLY (Contact BioTel for pediatric patients.)

  1. Continuously monitor vital signs, neurologic status, ECG, SPO2, and ETCO2, and transport.
  2. For additional patient care considerations not covered under standing orders, consult BioTel.

C. FOR PATIENTS WITH BRADYCARDIA SUSPECTED OF BEING CAUSED BY OVERDOSE OF A BETA-BLOCKER OR CALCIUM CHANNEL-BLOCKER:

  1. If altered mental status with bradycardia caused by beta-blocker toxicity, administer:

Adult

Pediatric


  1. If altered mental status with bradycardia caused by calcium-channel blocker toxicity, administer:

Adult

Pediatric

  1. Monitor vital signs, neurologic status, ECG, SpO2, ETCO2, and transport.
  2. For additional patient care considerations not covered under standing order, consult BioTel.
  3. Additional information on these agents may be found in the PHARMACOLOGY section.