Adult Bradycardia (with pulse)
HR < 50 with symptoms of hypoperfusion.
START
HR < 50, symptomatic?
ACTION
ABCs, O₂ if hypoxic, IV, monitor, 12-lead ECG
DECIDE
Signs of poor perfusion?
Hypotension, altered mental status, shock, chest pain, acute heart failure.
Yes — unstableAtropine 1 mg IV
No — monitorMonitor, treat underlying cause
DRUG
Atropine 1 mg IV
Repeat every 3–5 min, max 3 mg. First-line for unstable bradycardia.
ACTION
Transcutaneous pacing
If atropine ineffective or high-grade AV block (Mobitz II, 3°).
DRUG
Dopamine 5–20 mcg/kg/min OR Epinephrine 2–10 mcg/min
As an alternative or bridge to pacing. Consider expert consultation.
END
Monitor, treat underlying cause