Page 287 - PJ MED OPS Handbook 8th Ed

PALS Bradycardia
Pediatric Bradycardia With a Pulse Algorithm

Patient with bradycardia

Cardiopulmonary
compromise?
• Acutely altered No
mental status
• Signs of shock
• Hypotension
Yes
Assessment and support • Support ABCs
• Maintain patent airway • Consider oxygen
• Assist breathing with positive • Observe
pressure ventilation and oxygen • 12-Lead ECG
as necessary • Identify and treat
• Cardiac monitor to identify rhythm; underlying causes
monitor pulse, BP, and oximetry

Start CPR if HR <60/min
despite oxygenation and
ventilation.
No
Bradycardia
persists?
Yes
• Continue CPR if HR <60/min
• IV/IO access
• Epinephrine Doses/Details
• Atropine for increased vagal
Epinephrine IV/IO dose:
tone or primary AV block
0.01 mg/kg (0.1 mL/kg of the
• Consider transthoracic/
0.1 mg/mL concentration).
transvenous pacing
Repeat every 3-5 minutes.
• Identify and treat underlying If IV/IO access not available
causes but endotracheal (ET) tube
in place, may give ET dose:
0.1 mg/kg (0.1 mL/kg of the
1 mg/mL concentration).
Atropine IV/IO dose:
0.02 mg/kg. May repeat once.
Check pulse
Yes Minimum dose 0.1 mg and
every 2 minutes. maximum single dose 0.5 mg.
Pulse present?
Possible Causes
No • Hypothermia
• Hypoxia
Go to Pediatric • Medications
Cardiac Arrest Algorithm.
© 2020 American Heart Association
Appendix 2: Emergency Cardiovascular Care n 285