Pediatric Advance Life Support: Unstable Bradycardia

Bradyarrhythmia

·         Heart rate less than 60

·         Significant when accompanied by hypotension

·         Most common pre-arrest arrhythmia in pediatric patients

·         Often associated with hypoxemia, hypotension, and acidosis

Note:  Bradycardia, which is defined by a heart rate slower than 60 beats per minute, usually arises secondary to hypoxemia from airway compromise or ineffective respiration. The rhythm is usually sinus or junctional, but AV block may arise in the terminal phase.

Slow Rhythms

·         Heart Blocks

·         Bradycardia

·         Sinus Node arrest

·         Slow Junctional

·         Ventricular escape rhythms

Third Degree Heart Block

2nd Degree Heart Block Type II

Sinus Bradycardia

Sinus Arrest

Junctional Rhythm

Symptomatic Bradycardia

·         Symptomatic implies that an arrhythmia is causing symptoms, such as palpitations, lightheadedness, or dyspnea, but the patient is stable and not in imminent danger.

·         In such cases more time is available to decide on the most appropriate intervention

Unstable Bradycardia

·         Refers to a condition in which vital organ function is acutely impaired or cardiac arrest is ongoing or imminent.

·         When an arrhythmia causes a patient to be unstable, immediate intervention is indicated

Signs of Instability

·         Shock with hypotension

·         Altered mental status

·         Sudden collapse

·         Cold, clammy skin

·         Delayed capillary refill

·         Absent or weak pulses

Signs of End Organ Hypoprofusion

·         Depressed mental status

·         Decreased urine output

·         Metabolic acidosis

·         Tachypnea

·         Weak central pulses

·         Deterioration in color (eg, mottling, pallor, peripheral cyanosis)

Systolic Hypotension

● ˂60 mm Hg in term neonates (0 to 28 days)

● ˂70 mm Hg in infants (1 month to 12 months)

●˂70 mm Hg + (2 x age in years) in children 1 to 10 years

●˂90 mm Hg in children 10 years of age