Category: Other

Pediatric Bradycardia with a Pulse

Answer:


As management of pediatric bradycardia with a pulse is not currently in the ALS PCS, we recommend to consult with a Base Hospital Physician to discuss a management plan using the AHA Guidelines in your recommendations.

You can find the latest 2020 AHA Guidelines on the following website: https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf

Here are the highlights of the 2020 AHA Guideline for Pediatric Bradycardia with a Pulse:

If patient is bradycardic and presenting with cardiopulmonary compromise
Start with airway management, oxygenation and ventilation
If HR 60 despite oxygenation/ventilation
Start CPR
If Bradycardia persists
Continue CPR and monitor pulse q 2 min
Obtain vascular access (IV/IO) or ETT if IV/IO unavailable
Consider EPI IV/IO/ETT
IV/IO: EPI 0.1mg/ml concentration: 0.01mg/kg
ETT: EPI 1mg/mL concentration: 0.1mg/kg
Consider Atropine IV/IO for increased vagal tone or primary AV block
0.02mg/kg
minimum single dose: 0.1mg
maximum single dose: 0.5mg
Consider transcutaneous pacing
Identify and manage other possible underlying causes such as:
Hypoxia
Hypothermia
Medications / overdoses

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