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BRADYCARDIA

RESPOND


SYMPTOMATIC BRADYCARDIA
CHECK HEART RATE Confirm abnormally low heart rate or a significant rate drop from previous normal
PALS SURVEY
  1. Airway
  2. Breathing (Check O2 stats; administer O2 as needed)
  3. 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


  • 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 patient stops having a pulse, move to Cardiac Arrest Protocol.
  • Always consider the reversible causes of bradycardia in pediatric patients and treat if possible.
  • Atropine in doses less than 0.1mg may worsen bradycardia (paradoxical bradycardia).