All Emergencies - Basic life support principles:

  1. Maintain an airway
  2. Assess breathing
  3. Monitor circulation
Monitor and record all vital signs.

Although occasionally seen in healthy individuals, a heart rate slower than 60 beats per minute is usually caused by intrinsic cardiac disease, beta-blockers, vagal reflexes, or vagotonic medications.

  1. Intrinsic Cardiac Diseases
    1. Complete heart block
    2. Acute myocardial infarction
  2. Vagally mediated slowing of the SA node
    1. Direct eye pressure (Oculocardiac reflex)
    2. Direct pressure on the vagus or carotid sinus
  3. Medications
    1. Beta-blockers
    2. Anticholinesterases - neostigmine, edrophonium
    3. Narcotics
    4. Digitalis
    5. Local anesthetics
  4. Hypoxia - especially in children


Treatment for Bradycardia:

  1. Ensure that the patient is not hypoxic.
  2. For bradycardia due to vagal reflexes, rapid discontinuation of the stimuli may be sufficient
  3. If evidence of symptoms (= poor perfusion), consider using atropine
    For adults: 0.4 - 1.0 mg IV (not less than 0.4 mg)
    For children, 0.02 mg/kg, minimum 0.1 mg
  4. Pacemaker insertion may be necessary for intrinsic cardiac disease.
    If EKG shows 2nd degree block or 3rd degree AV block, use transcutaneous pacing without delay or contact EMS if pacing not available in dental office.