PALS Megacode - Bradycardia & Asystole

A 15-month-old infant is brought to the emergency department for evaluation of lethargy.

Initial vitals demonstrate:

T: 34, BP: 50/20, P: 50, O₂: 90%.
1. What is the initial step in management?*
- Administer atropine
- Cardiac pacing
- Initiate CPR
- Check blood sugar

You initiate CPR and provide supplement oxygenation.

Despite these interventions, clinical scenario is unchanged and child is persistently unresponsive.
2. What is the next step in management?*
- Discontinue CPR and intubate
- Synchronized cardioversion
- Cardiac pacing
- Administer epinephrine

You continue CPR but unfortunately there is no improvement.

On re-check of pulse, patient is now pulseless and monitor demonstrates the following:
3. What is the next step in management?*
- Defibrillate
- Synchronized cardioversion
- Continue CPR, administer epinephrine every 3-5 minutes
- Continue CPR, administer epinephrine every 10 minutes

You continue CPR and epinephrine administration every 3-5 minutes.

Fortunately, the patient regains a pulse and is demonstrating improving signs of perfusion, although remains unresponsive.
4. What are the next steps in management?*
- Continue comprehensive monitoring and assessment, consider pressor support, consider therapeutic hypothermia for persistently comatose patient
- You have completed resuscitation and no further management is required
- Immediately transfer patient to higher level or care
- Cardiac pacing

Bradycardia & Asystole