PALS Megacode: Unstable Pediatric Bradycardia Part 3

11: 49 PM. As you are transporting the 12 month old infant girl (10kg) who has ingested an unknown amount of her grandmother’s metoprolol to the local ER, you note that she remains unresponsive with agonal respirations.   CPR is in progress with positive pressure ventilations being provided.   An IO has been established in the proximal right tibia and a fluid bolus has been given.   One round of epinephrine has also been given without any change in the rhythm.   A 2^nd fluid bolus is being carefully administered.  Transcutaneous pacing is now being considered.

3rd degree heart block with pacing markers

11.What is the recommended pacing rate for a pediatric patient?

a.  60 beats per minute

b. 80 beats per minute

c. 100 beats per minute

d. 120 beats per minute

12.  What is meant by the term pacing threshold?

13.  How do you determine electrical capture on a pediatric patient?

3rd degree heart block with transcutaneous pacing

14.  How do you determine mechanical capture on a pediatric patient?

15.  Describe the procedure for initiating transcutaneous pacing on a pediatric patient.

Answers

11. c. 100 beats per minute

12. The minimum voltage required for ventricular capture

13. Ventricular capture is observed a pacer spike is immediately followed by a QRS complex

14. Mechanical capture is determined by palpating a pulse that matches the set pacing rate

15.

Set rate at 100 bpm
Set output at maximum and adjust downward to slightly above point where capture is achieved