If symptomatic or deteriorating bradycardia with HR < 60 BPM


►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)


►Establish IV Access (Do not delay pacing to establish IV)


250 mL NS bolus IV, repeat to max of 1 liter

If causing anxiety or extreme discomfort and BP greater than 90 systolic


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)

If Transcutaneous Pacing fails to capture and pace heart, stop pacing current and administer:

Atropine: 0.5 mg IV / 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:

Establish IV

If BP < 90 systolic and lungs clear

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

OK to try Pacing again after admin of drugs and fluids
Obtain 12-Lead EKG if immediate pacing not required

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