* Assess ABCs
* Secure Airway
* Administer Oxygen
* Start IV
* Attach monitor , Pulse Oximeter and BP.

* Assess Vital Signs
* Review History
* Perform Physical Examination
* Order 12 leads ECG
* Order Portable Chest X - Ray

Too Slow (< 60/min)

intervention sequence

2nd degree AVB Type II
or 3rd degree AVB ?

Class I , IIa

Observe

Class I

Class I

Class IIb

Class IIb

Serious signs or Symptoms (must be related to the slow rate) include:
Symptoms: Chest Pain , Shortness of Breath , decreased level of consciousness.
Signs: Low Blood Pressure , Shock , Pulmonary Congestion , CHF , Acute MI.

* Isoproterenol should be use , if at all , with extreme caution. At low
  doses it is Class IIb . At higher doses it is Class III (hamful)

Atropine should be given in repeat doses every 3-5 min , up to total dose of
0.03-0.04 mg / kg.  It has been suggested that Atropine should be used with
caution in AVB (AtrioVentricular Block) at the His-Purkinje level (2nd AVB Type II
and new 3rd AVB with wide QRS compexes) - (Class IIb)

Do not delay TCP while awaiting IV access or for Atropine to take affect
if patientis symptomatic.

Denervated transplanted hearts will not respond to Atropine.  Go at once to
Pacing , Catacholamin infusion , or both.

Never treat 3rd AVB plus ventricular escape beats with Lidocaine.

Verify patient tolerance and mechanical capture. Use Analgesia and Sedation
as needed.

Paramedic Neomi Zvi - Feb 2000

AHA ; ACLS ; 1994 ; 1-28  -  1-32