PROCTOR HOSPITAL EMS SYSTEM
Unstable Bradycardia SMO
First Responder Care BLS Care
1. Routine Patient Care SMO.
2. Oxygen: 15 L/min via non-rebreather mask or 6L/min via nasal cannula if the
patient does not tolerate a mask. If the patient has a known history of COPD,
titrate oxygen to maintain a PaO2 level of 90-93%.
3. Initiate ALS intercept and transport as soon as possible.
4. Contact Medical Control as soon as possible.
ILS Care
1. IV Access: Normal Saline (0.9% NaCl) Initiate IV/IO.
2. Atropine*: 0.5mg IV if the patient is hemodynamically unstable. May repeat
0.5mg IV every 5 minutes up to a total of 3mg or adequate profusion achieved.
3. Obtain 12-Lead EKG and transmit to receiving hospital as soon as possible.
4. Initiate ALS intercept and transport as soon as possible. (Transport can be
initiated at any time during this sequence).
5. Contact Medical Control as soon as possible.
ALS Care
1. Immediate Transcutaneous Pacing: If unresponsive to Atropine apply
Transcutaneous Pacing at a rate of 70 bpm.
2. Midazolam (Versed): 2mg IV/IO/PR for patient comfort after pacing is
initiated. Re-check vital signs 5 minutes after administration. May repeat dose
one time if systolic BP > 100mmHg and respiratory rate is > 10 rpm. Additional
doses require Medical Control order.
3. If systolic BP is less than 90. Dopamine: Begin infusion at 10mcgs/kg/min.
Increase by 5 mcgs/kg/min every 2 minutes to achieve and maintain a systolic
BP of at least 100mmHg. Closely monitor vital signs. Maximum dosage of 20
mcgs/kg/min.
Unstable Bradycardia SMO Page 1 of 4 Revised: 9/9/11
PROCTOR HOSPITAL EMS SYSTEM
Unstable Bradycardia SMO
ALS Care (continued)
The following chart may be used when the concentration is 1600 mcg/mL:
Dopamine Initial Dosage Chart
Concentration Starting dosage for treating hypotension 10 mcg/kg/minute
1600 mcg/mL
400 mg/250mL Increase by 5 mcg/kg/min
800 mg/500mL
Initial gtts per minute gtts/minute to increase rate
Weight # gtts per mL for IV tubing # gtts per mL for IV tubing
kg lbs 10 15 60 mL/hour 10 15 60 mL/hour
40 88 3 4 15 15.00 1 2 8 7.50
50 110 3 5 19 18.75 2 2 9 9.38
60 132 4 6 23 22.50 2 3 11 11.25
70 154 4 7 26 26.25 2 3 13 13.13
80 176 5 8 30 30.00 3 4 15 15.00
90 198 6 8 34 33.75 3 4 17 16.88
100 220 6 9 38 37.50 3 5 19 18.75
110 242 7 10 41 41.25 3 5 21 20.63
120 264 8 11 45 45.00 4 6 23 22.50
130 286 8 12 49 48.75 4 6 24 24.38
140 308 9 13 53 52.50 4 7 26 26.25
150 330 9 14 56 56.25 5 7 28 28.13
160 352 10 15 60 60.00 5 8 30 30.00
170 374 11 16 64 63.75 5 8 32 31.88
180 396 11 17 68 67.50 6 8 34 33.75
190 418 12 18 71 71.25 6 9 36 35.63
200 440 13 19 75 75.00 6 9 38 37.50
The above chart may be used to calculate the initial dosage for the Dopamine drip rate
when the Dopamine concentration is 1600 mcg/mL and micro-drip (60 gtts/mL) tubing is
used. When the chart is not available, you may start the dosage based on the following
formula WHEN THE CONCENTRATION IS 1600 mcg/mL AND micro-drip TUBING
IS USED:
gtts/min = patients weight in lbs/ 6
and increase calculated by
gtts/min = patient’s weight in lbs/ 12
You may increase dosage until the desired effect is reached up to a maximum rate
calculated by the formula:
Maximum gtts/min = patients weight in lbs/ 3
Unstable Bradycardia SMO Page 2 of 4 Revised: 9/9/11
PROCTOR HOSPITAL EMS SYSTEM
Unstable Bradycardia SMO
ALS Care (continued)
The following chart may be used when the concentration is 3200 mcg/mL:
Dopamine Initial Dosage Chart
Concentration Starting dosage for treating hypotension 10 mcg/kg/minute
3200 mcg/mL
800 mg/250mL Increase by 5 mcg/kg/min
1600 mg/500mL
Initial gtts per minute gtts/minute to increase rate
Weight # gtts per mL for IV tubing # gtts per mL for IV tubing
kg lbs 10 15 60 mL/hour 10 15 60 mL/hour
40 88 1 2 8 7.50 1 1 4 3.75
50 110 2 2 9 9.38 1 1 5 4.69
60 132 2 3 11 11.25 1 1 6 5.63
70 154 2 3 13 13.13 1 2 7 6.56
80 176 3 4 15 15.00 1 2 8 7.50
90 198 3 4 17 16.88 1 2 8 8.44
100 220 3 5 19 18.75 2 2 9 9.38
110 242 3 5 21 20.63 2 3 10 10.31
120 264 4 6 23 22.50 2 3 11 11.25
130 286 4 6 24 24.38 2 3 12 12.19
140 308 4 7 26 26.25 2 3 13 13.13
150 330 5 7 28 28.13 2 4 14 14.06
160 352 5 8 30 30.00 3 4 15 15.00
170 374 5 8 32 31.88 3 4 16 15.94
180 396 6 8 34 33.75 3 4 17 16.88
190 418 6 9 36 35.63 3 4 18 17.81
200 440 6 9 38 37.50 3 5 19 18.75
Unstable Bradycardia SMO Page 3 of 4 Revised: 9/9/11
PROCTOR HOSPITAL EMS SYSTEM
Unstable Bradycardia SMO
ALS Care (continued)
The following chart may be used when the concentration is 800mcg/mL:
Dopamine Initial Dosage Chart
Concentration Starting dosage for treating hypotension 10 mcg/kg/minute
800 mcg/mL
200 mg/250mL Increase by 5 mcg/kg/min
400 mg/500mL
Initial gtts per minute gtts/minute to increase rate
Weight # gtts per mL for IV tubing # gtts per mL for IV tubing
kg lbs 10 15 60 mL/hour 10 15 60 mL/hour
40 88 5 8 30 30.00 3 4 15 15.00
50 110 6 9 38 37.50 3 5 19 18.75
60 132 8 11 45 45.00 4 6 23 22.50
70 154 9 13 53 52.50 4 7 26 26.25
80 176 10 15 60 60.00 5 8 30 30.00
90 198 11 17 68 67.50 6 8 34 33.75
100 220 13 19 75 75.00 6 9 38 37.50
110 242 14 21 83 82.50 7 10 41 41.25
120 264 15 23 90 90.00 8 11 45 45.00
130 286 16 24 98 97.50 8 12 49 48.75
140 308 18 26 105 105.00 9 13 53 52.50
150 330 19 28 113 112.50 9 14 56 56.25
160 352 20 30 120 120.00 10 15 60 60.00
170 374 21 32 128 127.50 11 16 64 63.75
180 396 23 34 135 135.00 11 17 68 67.50
190 418 24 36 143 142.50 12 18 71 71.25
200 440 25 38 150 150.00 13 19 75 75.00
Unstable Bradycardia SMO Page 4 of 4 Revised: 9/9/11