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Respond to Bradycardia
| SYMPTOMATIC BRADYCARDIA | |
|---|---|
| CHECK HEART RATE | • Confirm abnormally low heart rate or a significant rate drop from previous normal |
| PALS SURVEY | A: Airway B: Breathing (Check O2 sats; administer O2 as needed) C: Circulation (Check blood pressure and rate; 12-lead ECG; IV/IO access) D: Disability (Check Neuro status) E: Exposure (Check for signs of trauma, burns, fractures, etc.) |
| CHECK FOR SIGNS/SYMPTOMS | • Are there symptoms of shock or acute change in mental status? • Are there symptoms being caused by the bradycardia? |
| BRADYCARDIA SYMPTOMATIC AND SERIOUS | • Do not delay CPR • Epinephrine 0.01 mg/kg IO/IV–Can be given every 3-5 minutes • Atropine 0.02 mg/kg IO/IV–Can be repeated once |
| DRUGS UNSUCCESSFUL | • Consider transthoracic/transvenous pacing (preferably with sedation) especially if bradycardia is the result of a complete heart block or an abnormal sinus node function • Seek expert consultation |
The primary goal of symptomatic bradycardia treatment is to make sure the heart is adequately pumping blood to the body (adequate perfusion).
Treatment is not necessarily aimed at increasing the heart rate.
Treatment should continue until symptoms/signs resolve.
If the person stops having a pulse, move to the Cardiac Arrest Protocol.
Always consider the reversible causes of bradycardia in pediatrics and treat if possible.
Atropine in doses less than 0.1 mg may worsen bradycardia (paradoxical bradycardia).
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Site Updated:
12/2024
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