🐢 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.
Adult Bradycardia Management (ACLS)
Situation
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.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.