# Bradycardia Management

## Overview

This module describes the emergent management of bradycardia, where the patient has a palpable pulse.

## Indications

1. Bradycardia with a palpable pulse

## Contraindications

1. Pulseless patients regardless of electrical activity on the monitor—treat according to cardiac arrest algorithms

## Patient information and consent

The management of bradycardia requires monitoring, administration of medication, and possibly transcutaneous pacing. Ensure that you explain your findings and decisions to the patient as you go along. Some patients may be haemodynamically unstable and unable to understand; communicate with family members if present. See Transcutaneous Pacing for specific patient information.

## Preparation

Bradycardia management may be an emergency procedure. Always:

1. Know where defibrillators, transcutaneous pads, and red trolleys are kept. Know the relevant staff and keep your seniors’ contact details close at hand.
2. Familiarise yourself with the defibrillators in your work area. Check that they are maintained regularly and have pads and the correct connections.
3. Keep unstable patients in resuscitation bays with continuous monitoring.

## Site & Positioning

The patient should be lying flat on their back on a firm surface. There should be space behind the head of the bed for staff to stand to give rescue breaths if the patient deteriorates.

## Procedure

Follow medical asepsis with non-sterile gloves.

## Troubleshooting

I am unfamiliar with or unsure about transcutaneous pacing.

Call a senior for assistance. Refer to Transcutaneous Pacing for guidance.

## Risks

1. Conversion to pulseless rhythm; death
2. Hypoxic injury
3. Drug reactions
4. Pain
5. Burns

## References

1. Resuscitation Council of Southern Africa. Bradycardia Management Algorithm. 2021.