Assess airway, breathing, circulation, blood pressure, mental status, and oxygen saturation
Obtain a 12-lead ECG and identify the rhythm and cause
Stop or reverse contributing medications if possible
Treat reversible causes such as hypoxia, hypothermia, electrolyte abnormalities, and ischemia
Give oxygen if hypoxemic
Establish IV access and continuous cardiac monitoring
If symptomatic or unstable, give atropine
If atropine is ineffective, start transcutaneous pacing
If pacing is unavailable or ineffective, start dopamine infusion
If pacing is unavailable or ineffective, start epinephrine infusion
Consider transvenous pacing for persistent or severe bradycardia
Treat specific causes such as myocardial infarction, sick sinus syndrome, or AV block
Seek urgent emergency care for syncope, chest pain, shortness of breath, hypotension, or altered mental status