|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).