Airway & Breathing
- Maintain a patent airway; support ABCs
- Assist with positive-pressure ventilation and oxygen as needed
Step 1 — Recognize Cardiopulmonary Compromise
In a bradycardic child, ask: is there compromised perfusion? Look for:
- Altered mental status
- Signs of shock or hypotension
- Poor pulses, cool extremities, delayed capillary refill
If compromise is present, move immediately to airway/ventilation support and monitoring.
Step 2 — Assessment & Support
Monitoring & Rhythm
- Attach a cardiac monitor and obtain a 12-lead ECG
- Track oximetry, blood pressure, and rhythm
- If compromise is absent, continue ABCs and evaluate for causes
Step 3 — When to Start CPR
Begin CPR if the heart rate is < 60/min despite adequate oxygenation and ventilation and there are signs of poor perfusion.
Step 4 — If Bradycardia Persists
- Continue CPR if HR < 60/min with poor perfusion
- Establish IV/IO access
- Epinephrine is first-line
- Atropine for increased vagal tone or primary AV block
- Consider transcutaneous pacing
- Identify and treat underlying causes (see below)
- Check pulse every ~2 minutes
- If pulse is lost → follow the Pediatric Cardiac Arrest algorithm
Medication Doses (Typical PALS)
| Medication | Dose / Route | Referral |
|---|---|---|
| Epinephrine | IV/IO: 0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL) | PALS Dosing |
| Atropine | 0.02 mg/kg IV/IO; may repeat once (min dose 0.1 mg) | PALS Dosing |
| Transcutaneous pacing | For refractory symptomatic bradycardia (esp. high-grade AV block) | Pacing Overview |
Always confirm doses with your local PALS card or institutional protocol.
Possible Causes to Treat
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