Defining the Rates
Bradycardia is a heart rate below 60 beats per minute, while tachycardia is above 100. The rate alone does not make an emergency. The key question is whether the patient shows signs of poor perfusion.
Signs of Instability
Unstable patients may have hypotension, altered mental status, chest pain, signs of shock, or acute heart failure. These patients need oxygen, airway support, and rapid advanced care. Athletes may have a normal resting bradycardia with no symptoms.
Prehospital Approach
Check for causes such as hypoxia, which is the most common cause of bradycardia in children. Provide oxygen, monitor, and keep the patient at rest. In an adult with a pulse of under 60 and poor perfusion, advanced providers may use atropine or pacing, so request ALS early.