Bradycardia
Description General Measures Medicine Treatment Referral ICD-10 code: R00.1 Refer to Adult Hospital Level and Paediatric Hospital Level STGs and EML for relevant guidance. DESCRIPTION In adults, bradycardia refers to a pulse rate < 50 beats/ minute. In children, bradycardia refers to a pulse rate < 60 beats/ minute despite effective oxygenation and ventilation. GENERAL MEASURES Assess ABC:
ICD-10 code: R00.1
Refer to Adult Hospital Level and Paediatric Hospital Level STGs and EML for relevant guidance.
DESCRIPTION
In adults, bradycardia refers to a pulse rate < 50 beats/ minute.
In children, bradycardia refers to a pulse rate < 60 beats/ minute despite effective oxygenation and ventilation.
GENERAL MEASURES
- Assess ABC:
- Airway: ensure airway is open and clear.
- Breathing: give oxygen to target pulse oximeter saturation of 94–98%.
- Circulation: assess peripheral perfusion, measure pulse and blood pressure.
- Attach ECG monitor, pulse oximeter and blood pressure cuff.
- Establish IV access.
- Print rhythm strip to confirm bradycardia; if possible, do 12 lead ECG.
- Assess for signs of instability:
- Hypotension
- Altered mental status
- Chest pain
- Acute heart failure
- Signs of shock: cold clammy peripheries and weak pulses
MEDICINE TREATMENT
Adults
If unstable:
- Atropine, IV, 0.5 mg as a bolus.
- Repeat every 3–5 minutes, if no response.
- Maximum dose: 3 mg.
- Look for and treat contributory causes for bradycardia (see table below).
- If no response to atropine, discuss with referral centre or refer to Adult Hospital Level STGs and EML for guidance.
If stable: Look for and treat contributory causes for bradycardia (see table below):
Table 21.1: Causes and treatment of bradycardia
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Contributory causes for bradycardia and treatment
|
|
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Hypoxia
|
Give supplemental oxygen or ventilate.
|
|
Hypothermia
|
Warm the patient.
|
|
Head injury
|
Give oxygen, elevate head of bed.
|
|
Heart block
|
Look for cause of heart block.
|
|
Hydrogen ion (acidosis)
|
Look for cause of acidosis.
|
|
Hypotension
|
If no signs of heart failure:
- Sodium chloride 0.9%, IV, 200 mL.
|
|
Toxins and therapeutic agents
|
Treat as for specific overdose.
|
Children
If unstable:
- Start CPR:
- 30 compressions: 2 breaths (1 rescuer), or
- 15 compressions: 2 breaths (2 rescuers)
- Adrenaline (epinephrine), IV, 0.1 mL/kg of 1:10 000 solution (Doctor prescribed).
- To make 1:10 000 adrenaline (epinephrine) solution: dilute 1 mL ampoule of adrenaline (epinephrine) (1:1000) with 9 mL of sodium chloride 0.9% to give 10 mL of 1:10000 solution.
- Administer dose every 3–5 minutes, according to table below.
|
Weight
kg
|
Dose
mg
|
Volume of Diluted Solution
(1:10 000 solution)
|
Age
months/ years
|
|
>2.5–7 kg
|
0.05 mg
|
0.5 mL
|
Birth–6 months
|
|
>7–11 kg
|
0.1 mg
|
1 mL
|
>6–18 months
|
|
>11–17.5 kg
|
0.15 mg
|
1.5 mL
|
>18 months–5 years
|
|
>17.5–25 kg
|
0.2 mg
|
2 mL
|
>5–7 years
|
|
>25–35 kg
|
0.3 mg
|
3 mL
|
>7–11 years
|
|
>35–55 kg
|
0.5 mg
|
5 mL
|
>11–15 years
|
If heart block or increased vagal tone suspected:
- Atropine, IV, 0.02 mg/kg/dose as a single dose (Doctor prescribed).
- Maximum single dose: 0.5 mg.
- Repeat dose, if no response.
If stable:
- Look for and treat contributory causes for bradycardia (see Table 21.1 above).
- Close monitoring required.
- Ensure adequate oxygenation and ventilation if necessary.
REFERRAL
Urgent
All patients: transfer with supportive care and accompanying skilled worker until taken over by doctor at receiving institution.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-4_Version 1.1_October 2024
Chapter 21: Emergencies and Injuries