Browse categories and answer follow-up questions to refine your symptom profile.
Immediate priorities
Unstable bradyarrhythmia approach
Airway compromise
If apnea or severe hypoventilation, bag valve mask and advanced airway pathway
Oxygenation and ventilation targets
SpO2 94 to 98 percent
Perfusion failure features
Hypotension
Altered mental status
Ischemic chest discomfort
Acute pulmonary edema
If perfusion failure features present, immediate ACLS bradycardia algorithm pathway
Monitoring and access
Cardiac monitor with pacing capability
Defibrillator pads in anterior posterior position
Noninvasive blood pressure cycling every 1 to 3 minutes
If shock or vasoactive infusion, arterial line when feasible
IV access
Two large bore peripheral IV lines
Point of care glucose
If hypoglycemia, immediate dextrose therapy
Rhythm confirmation workflow
12 lead ECG within 10 minutes
Rate
PR interval
QRS width
AV association
If bradycardia with wide QRS, high likelihood infranodal disease
Higher risk atropine failure
If second degree Mobitz II or third degree AV block, pacing first strategy
Atropine not relied on as definitive therapy
Rapid causes and reversible triggers
Immediate reversible causes screen
Ischemia or infarction
STEMI pathway if indicated
Drugs and toxicologic
Beta blockers
Calcium channel blockers
Digoxin
Antiarrhythmics
Opioids or sedatives
Hypoxia
Airway or ventilation failure
Electrolyte abnormality
Hyperkalemia
Hypothermia
Endocrine
Hypothyroidism myxedema
Increased vagal tone
Vomiting
Pain
Carotid sinus hypersensitivity
ECG based classification
Bradyarrhythmia patterns
Sinus bradycardia
P waves present with fixed PR
Junctional rhythm
Absent or inverted P waves
Ventricular escape rhythm
Wide QRS with very slow rate
First degree AV block
PR over 200 ms
Second degree AV block Mobitz I
Progressive PR prolongation then dropped QRS
Second degree AV block Mobitz II
Fixed PR with intermittent dropped QRS
High grade AV block
Two or more consecutive nonconducted P waves
Third degree AV block
AV dissociation with independent atrial and ventricular rates
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.