List clinical features.
Acute altered mental status
Ischemic chest pain
Acute heart failure
Hypotension
Signs of shock despite adequate airway and breathing
Describe the adult unstable bradycardia algorithm.
Start initial management of bradycardia and immediate hemodynamic support simultaneously with the following treatment:
First-line: IV atropine
If refractory to atropine: Start temporizing measures.
Transcutaneous pacing
AND/OR IV pharmacotherapy
Dopamine
OR Epinephrine
If refractory to pharmacotherapy: Consult cardiology for transvenous pacing.
Concurrently treat reversible causes of bradycardia, e.g., hypoxia, hyperkalemia, acute coronary syndrome, beta blocker toxicity, CCB toxicity, cardiac glycoside toxicity.
Algorithm (figure).
Describe the management.
Begin definitive therapy for specific bradyarrhythmias under specialist guidance.
Identify indications for permanent pacemaker insertion.
Continue treatment of the underlying cause of bradycardia.
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