🐢 Adult Bradycardia Management (ACLS)
UseUse to triage bradycardia by severity — observe if well-perfused, escalate to atropine and pacing if symptoma…
SourceAHA 2025 Adult Bradycardia Algorithm
This-shift next steps
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Methodology · worked example, guidelines & full notes
Atropine is usually ineffective in Mobitz II, third-degree block, or new wide-QRS escape — pace early rather than delaying with repeated atropine. (original synthesis · not guideline verbatim)
When to use
Use to triage bradycardia by severity — observe if well-perfused, escalate to atropine and pacing if symptomatic, and pace first for high-grade (infranodal) block — while always seeking reversible causes.
How it works
Branches: stable (observe, treat reversible causes) → symptomatic (atropine 1 mg q3–5min, max 3 mg → TCP or dopamine 5–20 μg/kg/min (taper slowly) or epinephrine 2–10 μg/min) → high-grade block (pacing first, bridging infusions).
Key points
- Atropine is usually ineffective in Mobitz II, third-degree block, or new wide-QRS escape — pace early rather than delaying with repeated atropine. (original synthesis · not guideline verbatim)
- Atropine dose is 1 mg every 3–5 minutes to a maximum of 3 mg
- Transcutaneous pacing, dopamine infusion, and epinephrine infusion are equivalent second-line options titrated to clinical improvement.
References
- [Guideline / primary source]AHA 2025 Adult Bradycardia Algorithm
- American Heart Association — Adult Bradycardia Algorithm.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Situation | Symptomatic (hypotension/acute altered mental status/shock/ischemic chest pain/decompensated heart failure) |
|---|
→ACLS bradycardiaAtropine → pacing/infusion
- Atropine (first-line)：1 mg IV/IO, repeat every 3–5 minutes, maximum cumulative 3 mg
- If ineffective (second-line, equivalent)：Transcutaneous pacing (TCP, immediately available); or dopamine infusion 5–20 μg/kg/min (taper slowly); or epinephrine infusion 2–10 μg/min. Titrate all to clinical improvement
- Further：Consider transvenous pacing, expert (cardiology/EP) consult; correct reversible causes (ischemia, hyperkalemia, drug toxicity — e.g. glucagon for β-blocker, antibody for digoxin)
| Situation | Well-perfused / no serious symptoms |
|---|
→ACLS bradycardiaObserve and monitor
- Management：Maintain airway/oxygen (if needed), monitor, establish IV access, 12-lead ECG; identify and treat reversible causes (H's & T's, drugs, electrolytes, ischemia)
- Follow-up：No immediate medication needed if no serious symptoms; continue observation, specialist consult if needed
- Basis：AHA 2025 Adult Bradycardia Algorithm
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Adult Bradycardia Management (ACLS)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Adult Bradycardia Management (ACLS) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Adult Bradycardia Management (ACLS) calculated in practice? Can you show a worked example?
- Inputs: Situation Symptomatic (hypotension/acute altered mental status/shock/ischemic chest pain/decompensated heart failure) → Result: ACLS bradycardia Atropine → pacing/infusion（Atropine (first-line): 1 mg IV/IO, repeat every 3–5 minutes, maximum cumulative 3 mg, If ineffective (second-line, equivalent): Transcutaneous pacing (TCP, immediately available); or dopamine infusion 5–20 μg/kg/min (taper slowly); or epinephrine infusion 2–10 μg/min. Titrate all to clinical improvement, Further: Consider transvenous pacing, expert (cardiology/EP) consult; correct reversible causes (ischemia, hyperkalemia, drug toxicity — e.g. glucagon for β-blocker, antibody for digoxin)） Inputs: Situation Well-perfused / no serious symptoms → Result: ACLS bradycardia Observe and monitor（Management: Maintain airway/oxygen (if needed), monitor, establish IV access, 12-lead ECG; identify and treat reversible causes (H's & T's, drugs, electrolytes, ischemia), Follow-up: No immediate medication needed if no serious symptoms; continue observation, specialist consult if needed, Basis: AHA 2025 Adult Bradycardia Algorithm）