Pediatric Advance Life Support: Unstable Bradycardia

Stable patient

·         Observe

·         Support ABCs

·         Reassess patient for symptoms of cardiac compromise

Note:  Reassess the patient to determine if bradycardia is still causing cardiorespiratory symptoms despite support of adequate oxygenation and ventilation

Unstable patient

·         Perform chest compression

·         Heart rate < 60/min in infant or child with poor systemic perfusion despite oxygenation

Note:  Revaluate the patient for signs of compromised cardiac output, including reduced responsiveness, weak central pulses, weak or absent peripheral pulses, hypotension, delayed capillary refill, and cool extremities.

Drug Management

·         Epinephrine

·         Atropine

·         Dopamine

·         Transcutaneous pacing

Drug Therapy

·         If ventilations and oxygen fail to correct bradycardia, consider drug therapy

·         Epinephrine 0.01mg/kg (0.1ml/kg of a 1:10,000 solution) IV or IO q3-5minutes

·         Epinephrine 0.1mg/kg (0.1ml of a 1:1000 solution) via ET tube q3-5minutes

·         Continuous infusion 0.1-0.3ug/kg titrate for effect for persistent bradycardia

Drug Therapy

·         Atropine 0.02mg/kg with minimum dose of 0.1mg IV or IO

·         Maximum single dose of 0.5mg for a child and 1mg for an adolescent

·         May repeat in 5 minutes to maximum cumulative dose of 1mg in child and 2mg in an adolescent

·         0.04-.06mg/kg via ET tube

Note:  Atropine sulfate is a parasympatholytic drug that accelerates sinus or atrial pacemakers and increases the speed of AV conduction.

If bradycardia is known or strongly suspected to be caused by increased vagal tone or primary AV heart block, administer atropine preferentially after establishment of oxygenations and ventilation

Atropine Indications

·         Increased vagal tone

·         Cholinergic drug toxicity- organophosphates

·         Complete heart block

·         Congenital heart problems

Drug therapy

·         Dopamine may be added for BP support

·         Dose range 2-20ug/kg/min

·         May cause tachycardia at high doses