Bradyarrhythmia

Pediatric Bradycardia With a Pulse and Poor Perfusion

• 1. Identify and treat underlying cause • Maintain patent airway; assist breathing as necessary • Oxygen • Cardiac monitor to identify rhythm; monitor blood pressure and oximetry • IO/IV access • 12-Lead ECG if available; don't delay therapy
• 2. Cardiopulmonary compromise continues?
• If No → 4A. • Support ABCs • Give oxygen • Observe • Consider expert consultation
• If Yes → 3. CPR if HR <60/min with poor perfusion despite oxygenation and ventilation
• 4. Bradycardia persists?
• If No → 4A. Support ABCs, give oxygen, observe, consider expert consultation
• 5. If Yes → • Epinephrine • Atropine for increased vagal tone or primary AV block • Consider transthoracic pacing/transvenous pacing • Treat underlying causes
• 6. If pulseless arrest develops, go to Cardiac Arrest Algorithm*

Cardiopulmonary Compromise

• • Hypotension
• • Acutely altered mental status
• • Signs of shock

Doses/Details

• Epinephrine IO/IV Dose: 0.01 mg/kg (0.1 mL/kg of 1:10,000 concentration). Repeat every 3-5 minutes. If IO/IV access not available but endotracheal (ET) tube in place, may give ET dose: 0.1 mg/kg (0.1 mL/kg of 1:1,000).
• Atropine IO/IV Dose: 0.02 mg/kg. May repeat once. Minimum dose 0.1 mg and maximum single dose 0.5 mg.