Sinus Bradycardia

View Rhythm Strip
Transcutaneous PacingStep-by-step setup, capture & troubleshooting
TC Pacing — Quick Steps
Full guide →
  1. Apply pads anterior–posterior; attach ECG leads from the pacer/monitor.
  2. Pre-medicate for discomfort: midazolam ± fentanyl if BP allows.
  3. Set mode Demand (synchronous), rate 60–80/min.
  4. Increase output (mA) by 5–10 until electrical capture (wide QRS after each spike).
  5. Confirm mechanical capture: palpate femoral/right brachial pulse (not carotid).
  6. Set final output ~10 mA above threshold; reassess BP, perfusion, mentation.
  7. Bridge to transvenous pacing or treat underlying cause.
ANTERIORANTPOSTERIORPOSTSandwich the heart between pads
A–P pad placement

Rhythm strip

Source ↗
Normal P before each QRSRate < 60Narrow QRS
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Tap a label on the strip to highlight the matching feature below.

  • Normal P before every QRS, normal PR
  • Rate < 60 (often < 50 if symptomatic)
  • Narrow QRS — distinguishes from escape rhythms
Recognition
  • Normal P before every QRS, normal PR
  • Rate < 60 (often < 50 if symptomatic)
  • Differentiate from AV blocks and junctional escape
Causes / triggers
  • Physiologic (athletes, sleep)
  • Drugs: beta-blockers, CCBs, digoxin, clonidine, opioids
  • Ischemia (esp. inferior MI)
  • Hypothyroidism, hypothermia, ↑ ICP, hyperkalemia
  • Vagal stimulation
Management
Symptomatic / unstable bradycardia (ACLS)
  • 1 mg IV bolus, repeat q3–5 min, max 3 mg
  • 2–10 mcg/min infusion, OR
  • 5–20 mcg/kg/min infusion
  • (drugs, K, ischemia, hypoxia)
Avoid atropine if
  • (Mobitz II / 3°) with wide-complex escape — pacing instead
  • (denervated)

Educational reference only. Always follow current ACLS guidelines and institutional protocols.