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Updated 10/01/2021


If symptomatic or deteriorating bradycardia with HR < 60 BPM


►Establish IV Access, consider IO if attempts at IV are not successful

(For stable patients, obtain 12 lead. With signs of poor perfusion or other symptoms start therapy)

Atropine: 1 mg IV / / IO / IM approximately every 3 minutes as needed to correct bradycardia to a max of 3 mg

For systolic BP less than 90 (paced or not capture) or no response to Atropine; and Lungs clear:

250 mL NS bolus IV, may repeat 3 times to 1 liter (assess lung sounds, discontinue fluid infusion if rales develop)

If unable to attain IV/IO or Atropine fails to improve heart rate, continue Atropine dosing and start pacing

►Initiate Pacing (See Transcutaneous Pacing)

Transcutaneous Pacing

Set Rate at 70 BPM and mAto 0
Slowly increase mA until electrical (Monitor) and mechanical (Pulse) capture (max 120 mA) If still symptomatic increase the heart rate from 70 BPM (max of 100 BPM)

Versed (Midazolam): up to 5 mg IV titrate to attain sedation

If IV cannot be established and BP greater than 90 systolic

Versed (Midazolam): 5 mg IN (may repeat once after 3 minutes)

OK to try Pacing again after admin of drugs and fluids

OK to administer Atropine while starting Pacing, if Atropine alone is not working
Obtain 12-Lead EKG if immediate pacing not required

BHC – Base Contact for all pacing pt’s for possible CVRC designation

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