Adults

Bradycardia – Unstable

Diagnosis

HR < 50 bpm with hypotension, acutely altered mental status, shock, ischemic chest discomfort, or acute heart failure

Diagnosis

HR < 50 bpm with hypotension, acutely altered mental status, shock, ischemic chest discomfort, or acute heart failure

  1. Call for help and a code cart

    • Ask: "Who will be the crisis manager?"
    • Crisis manager designates checklist reader

  2. Turn FiO2 to 100%

    • Verify oxygenation/ventilation adequate
    • Consider securing airway

  3. Administer atropine

    • 0.5 - 1 mg IV, may repeat up to 3 mg total

  4. Stop surgical stimulation (if laparoscopy, desufflate)

  5. If atropine ineffective:

    • Consider EPINEPHrine or DOPamine
    • - or -
    • Start transcutaneous pacing (see box)
    • 0.5 - 1 mg IV, may repeat up to 3 mg total
    • BOLUS: 10 - 100 MICROgrams IV, repeat as needed
    • INFUSION: 0.01 - 0.1 MICROgrams/kg/min
    • 2 - 20 MICROgrams/kg/min IV infusion

  6. Consider...

    • Assessing and treating underlying etiology (see differential diagnosis box)
    • If hemodynamically unstable, minimizing volatile anesthetics
    • Calling cardiology consult

  7. If bradycardia progresses to asystole or PEA arrest

Patient weight

Between 30 kg and 250 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.