🐢 Adult Bradycardia Management (ACLS)
This tool summarizes ACLS management of adult symptomatic bradycardia: atropine first-line, then transcutaneous pacing or dopamine/epinephrine infusion, per AHA 2020.
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)
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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 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; a single dose < 0.5 mg can paradoxically slow the rate.
- Transcutaneous pacing, dopamine infusion, and epinephrine infusion are equivalent second-line options titrated to clinical improvement.
References
- Panchal AR, et al. Part 3: Adult Basic and Advanced Life Support (bradycardia). AHA Guidelines. Circulation 2020.
- 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 | 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 ACLS adult bradycardia guideline 2020
| Situation | Mobitz II / third-degree AV block / new wide-QRS escape |
|---|
→ACLS bradycardiaPacing first (atropine usually ineffective)
- Pacing priority：Mobitz II/third-degree block/new wide-QRS escape are infranodal lesions; atropine is usually ineffective → transcutaneous pacing (TCP) as soon as possible, prepare transvenous pacing
- Bridging medication：Before pacing/if ineffective, use dopamine 5–20 μg/kg/min or epinephrine 2–10 μg/min to maintain rate and perfusion
- Consult：Early cardiology/EP consult to evaluate permanent pacing
Frequently asked questions
- What is Adult Bradycardia Management (ACLS)?
- This tool summarizes ACLS management of adult symptomatic bradycardia: atropine first-line, then transcutaneous pacing or dopamine/epinephrine infusion, per AHA 2020.
- How is Adult Bradycardia Management (ACLS) calculated? What is the core formula?
- Branches: stable (observe, treat reversible causes) → symptomatic (atropine 1 mg q3–5min, max 3 mg → TCP or dopamine 5–20 μg/kg/min or epinephrine 2–10 μg/min) → high-grade block (pacing first, bridging infusions).
- When is Adult Bradycardia Management (ACLS) used?
- 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.
- What are the key clinical points for Adult Bradycardia Management (ACLS)?
- 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; a single dose < 0.5 mg can paradoxically slow the rate. Transcutaneous pacing, dopamine infusion, and epinephrine infusion are equivalent second-line options titrated to clinical improvement.
- 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.
- How is Adult Bradycardia Management (ACLS) calculated in practice? Can you show a worked example?
- 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 ACLS adult bradycardia guideline 2020） Inputs: Situation Mobitz II / third-degree AV block / new wide-QRS escape → Result: ACLS bradycardia Pacing first (atropine usually ineffective)（Pacing priority: Mobitz II/third-degree block/new wide-QRS escape are infranodal lesions; atropine is usually ineffective → transcutaneous pacing (TCP) as soon as possible, prepare transvenous pacing, Bridging medication: Before pacing/if ineffective, use dopamine 5–20 μg/kg/min or epinephrine 2–10 μg/min to maintain rate and perfusion, Consult: Early cardiology/EP consult to evaluate permanent pacing）