Management of Bradycardia
| SYMPTOMATIC BRADYCARDIA | |
| CHECK HEART RATE | • Confirm abnormally low heart rate or a significant rate drop from previous normal |
| PALS SURVEY | A: Airway B: Breathing (Check O2 sats; administer O2 as needed) C: Circulation (Check blood pressure and rate; 12-lead ECG; IV/IO access) D: Disability (Check Neuro status) E: Exposure (Check for signs of trauma, burns, fractures, etc.) |
| CHECK FOR SIGNS/SYMPTOMS | • Are there symptoms of shock or acute change in mental status? • Are there symptoms being caused by the bradycardia? |
| BRADYCARDIA SYMPTOMATIC AND SERIOUS | • Do not delay CPR • Epinephrine 0.01 mg/kg IO/IV–Can be given every 3-5 minutes • Atropine 0.02 mg/kg IO/IV–Can be repeated once |
| DRUGS UNSUCCESSFUL | • Consider transthoracic/transvenous pacing (preferably with sedation) especially if bradycardia is the result of a complete heart block or an abnormal sinus node function • Seek expert consultation |
Table 15
Take Note
- The primary goal of symptomatic bradycardia treatment is to make sure the heart is adequately pumping blood to the body (adequate perfusion).
- Treatment is not necessarily aimed at increasing the heart rate.
- Treatment should continue until symptoms/signs resolve.
- If the person stops having a pulse, move to the Cardiac Arrest Protocol.
- Always consider the reversible causes of bradycardia in pediatrics and treat if possible.
- Atropine in doses less than 0.1 mg may worsen bradycardia (paradoxical bradycardia).