Respond to Bradycardia

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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 stats; administer O2 as needed)
C: Circulation (Check blood pressure and rate; 12-lead ECG; IV/IO access)
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 UNSUCCESSFULL • 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

Table 15

Take Note
  • 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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