Bradycardia is defined as an expected heart rate of less than 60 beats per minute. It can be physiological (eg in athletes), cardiac in origin (atrioventricular block or sinus disease), non-cardiac in origin (vasovagal reaction, hypothermia, hypothyroidism, hyperkalemia), or drug-induced. The normal heart rate for adults is between 60 and 100 beats per minute.

The patient should be assessed using the ABCDE approach. It is important to identify the causes of bradycardia and determine if there are any unwanted signs. If adverse signs are present, bradycardia treatment should be initiated.

UNWANTED SIGNS:

• Systolic pressure
• Heart rate
• Ventricular arrhythmias that disrupt blood pressure and require treatment
• Impaired heart function

IF ONE OR MORE UNWANTED CHARACTERS ARE PRESENT:

• Establish venous access
• Apply oxygen
• Set up an ECG monitor (continuous monitoring)
• Perform a 12-lead ECG
• Oxygen saturation monitoring
• Blood pressure monitoring and control
• Prepare and administer atropine (0.5 mg atropine IV, if necessary, repeat every 3-5 minutes to a maximum of 3 mg)
• Transport to the hospital
• CAUTION! If there is acute myocardial ischemia or acute myocardial infarction

If medications do not work, consider noninvasive cardiac pacing.

For bradycardia with adverse signs due to diaphragmatic myocardial infarction unresponsive to atropine, bradycardia due to spinal cord injury, and heart transplant recipients, consider aminophylline.

For stable patients without adverse signs or those who respond well to atropine, consider the risk of asystole.

IF THERE IS A RISK OF ASYSTOLE:

• Recent asystole
• Mobitz type II AV block
• Complete AV block (third degree), especially with a wide QRS complex or frequency of ventricular arrhythmias> 3 seconds
• Initiate transcutaneous cardiac pacing if there is no response to atropine and the patient remains unstable with signs of circulatory failure.
• Monitor the patient and try to determine the cause of the bradycardia.
• If transcutaneous pacing is not immediately available or not effective, consider administration of epinephrine.

References: Prehospital Emergency Medicine Guidelines, 2011 ERC Guidelines. years