Marquette County EMS Medical Control Authority
Part 1 Section 1
Cardiac Problems - Bradycardia/Heart Block ALS
This Protocol may be used in conjuction
with the Cardiac Arrest Protocol
Utilize Universal Precautions -TCP should not be delayed while attempting IV or
Evaluate/maintain airway. Provide oxygen per Airway awaiting Atropine to take effect.
Procedure -Lidocaine is usually contraindicated for ectopy in
Assess adequacy of perfusion; LOC, pulse, b/p, capillary bradycardia, the ectopy is usually secondary to the
refill and signs of CHF. bradycardia.
Obtain Baseline history; IPS; & Allergies/'monitor EKG and -In peds, bradycardia is usually a result of hypoxia
Heart rate < 60 No Go to Shock Protocol
Consider CPR/Intubation per Airway Procedure
Unstable with serious signs
Yes Transcutaneous Pacemaker; See Electrical Therapy Procedure
Obtain IV access/Consider Sedation for TCP 5 mg Valium IVP
Atropine 1 mg IVP or ET (2 mg ET) in adult;
For peds, [0.02 mg/kg IVP (0.2 ml/kg) Min dose 0.1 mg;
max dose 1.0 mg]
No Repeat Atropine every 3-5 min to a total of 0.04 mg/kg in adult; 3mg
Transport Position of Comfort
Monitor vitals & patient
Obtain IV access if not previously done
Transport in manner as to not alarm the patient.
Possible Post Contact Orders:
Contact -Dopamine IV drip; start at 3 mcg/kg/min; titrate to rate and b/p
Medical -Epi drip; 1 mg of 1:1,000 into 250 D5W (4mcg/ml) run at 2-10
-Peds, 0.1 mg/kg of Epi 1:1,000(max of 2mg) diluted to 1ml/kg
with NS to max of 10ml; Epi drip not to be used in peds.
Notes: Treat only symptomatic bradycardia.
1. Serious s/s must be related to the slow rate. Associated
symptoms such as chest pain, dizziness, SOB, fainting, abdominal
pain, sudden or gradual onset of palpitations, proceed with
treatment for bradycardia.
2. Pulse oximetry and CO2 monitoring in low perfusion states may
Authentication And Approval:
Marquette County EMS Medical Director Date:
Effective Date: 10/19/89; Revision Date: 5/5/98