PALS Megacode: Unstable Pediatric Bradycardia Part 1

11:30 PM. You are dispatched to the home of an elderly lady who called and said that she was awakened by the sound of her granddaughters “noisy, gurgling, breathing.”   She stated that her granddaughter still does not look like she is “breathing right.”   When you arrive, you find a 12 month old girl who is cyanotic with irregular gasping respirations.   She is unresponsive with a weak, thready,  pulse of 35.  CPR with positive pressure ventilations are initiated.   The grandmother, who was watching the toddler, stated that she apparently crawled into her room and reached up on the nightstand and had taken her “heart medications.”  She presents you with an opened pill box that contained her weekly doses of metoprolol.   The toddler is placed on the monitor and the initial rhythm is as follows.

1.  Identify the above rhythm.

a. Idioventricular rhythm

b. Junctional rhythm

c. Mobitz II

d. Complete heart block

2.  In pediatric patients, what are the most common causes of bradydysrhythmias?

a.  Congenital heart problems

b.  Hypoxia

c.  Overdose

d.  Drowings

3.  When responding to a pediatric emergency, what is indicated when the heart rate is less than 60 and accompanied by signs of poor perfusion?

a.  Begin transvenous pacing

b.  Immediate cardiopulmonary resuscitation

c.  Immediate transcutaneous pacing

d.  Epinephrine 0.01mg/kg IV or IO q3-5 minutes

4.  What is the rate of compressions when performing infant CPR?

a. 30 compression per minute

b. 60 compressions per minute

c. 90 compressions per minute

d. 100 compressions per minute

5.  Where do you check for a pulse on an infant?

a.  On the carotid artery

b.  The femoral artery

c.  The radial artery

d.  The brachial artery

Answers

1. d. Complete heart block

2. b. Hypoxia

3. b. Immediate cardiopulmonary resuscitation

4. d. 100 compressions per minute

5. d. The brachial artery