Algorithm in giving Emergency Care to BRADYCARDIA

21/08/2009 18:17

BRADYCARDIA... What to do?????

1.      Maintain patent airway

2.      Give Oxygen

3.      Monitor ECG (identify rythm), Blood pressure, Oximetry

4.      Establish IV access

5.      Observe for Adequate or Poor Perfusion: 

Signs of Poor perfusion: Acute altered mental status, Ongoing chest pain, Hypotension and other signs of shock

a.      If there is adequate perfusion: OBSERVE/MONITOR

b.      If there is POOR PERFUSION

                                      i.      Prepare for TRANSCUTANEOUS PACING

Use without delay for high degree block,  Type II second degree block, or third degree AV block

                                     ii.      Consider ATROPINE 0.5 mg IV while awaiting pacer.  May repeat a total dose of 3 mg.  If ineffective begin pacing.

                                    iii.      Consider EPINEPHRINE 2-10 microgram or DOPAMINE (2-10 microgram/kg/minute)

                                                           iv.      Then, Prepare for Transvenous pacing

1.      Treat contributing causes

2.      Consider expert consultation



·         ST Elevation MI (STEMI)

·         Non- ST Elevation MI (NSTEMI)

·         Unstable Angina (UA) – Also non ST elevation but has (-) Troponin, cardiac enzyme


Fibrinolytic Therapy:

            Streptokinase – 1.5 Million units in D5W 90ccx1 hr

            Premedication with 100 mg IV Hydrocortisone and 50 mg IV Diphenhydramine

Tissue Plasminogen Activator

            tPA – 15 mg IV Bolus

            0.75/kg over next 30 minutes (not to exceed 50 mg)

            0.5 mg/kg over next 60 minutes (not to exceed 35 mg)


*If there are signs of shock, fibrinolytic therapy is contraindicated and PCI is the treatment of choice.


Absolute contraindications to fibrinolytic therapy:

1.      Any prior intracranial hemorrhage

2.      Known structural cerebral vascular lesion (e.g. arteriovenous malformation)

3.      Ischemic stroke within 3 months except acute ischemic stroke within 3 hours

4.      Active internal bleeding (excluding menses) or bleeding diathesis

5.      Suspected aortic dissection

6.      Significant closed head or facial trauma within 3 months