EMS Protocol of the Week - Brady-Dysrhythmia (Adult)

Joe Liu gave us a great overview of some tachyarrhythmia protocols recently, so I figured I should earn my keep and balance things out with a review of prehospital management of bradydysrhythmias. As always, the first question on scene is going to be whether the rhythm is stable or unstable – does the patient seem to be perfusing well with that low heart rate, or is there evidence of shock?

If it’s the former, OLMC may receive a call to discuss administering one of the Medical Control Options for this protocol, which include atropine, inotropic agents such as dopamine and epinephrine, and reversal/stabilizing agents such as calcium chloride and sodium bicarbonate. Use your discretion with authorizing these meds, understanding that just because the patient appears stable now doesn’t mean they can’t decompensate en route.

If it’s the latter, paramedics will have a bit more autonomy with their Standing Orders, which call for an initial dose of atropine, as well as transcutaneous pacing if needed.

Take your time to really read through the medication options in this protocol, as well as their indications. Remember, slow and steady wins the race (but slow and irregular may get zapped).

www.nycremsco.org and the protocol binder for more!

Dave