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Pediatric Bradycardia With A Pulse and Poor Perfusion - Updated 2018

Bradycardia is a heart rate lower than normal for a child’s age and activity level. Usually less than 60 BPM indicates bradycardia in a child, and if the child is experiencing this low of a heart rate with adequate oxygenation and ventilation, begin CPR immediately. It is often a sign of impending cardiac arrest in infants and children especially when accompanied by hypotension or evidence of inadequate tissue perfusion.

Pediatric Bradycardia Algorithm (With a pulse and poor perfusion) Download Printable Algorithm

Algorithm Notes

STEP 1

Identify and treat underlying cause

Follow the ABC Survey:

Airway: Support or open the airway by positioning the child in a position of comfort and performing manual airway maneuvers if necessary.

Breathing: Give O2 in high concentration, utilize bag-mask ventilation if needed/available and attach a pulse oximeter to assess oxygenation.

Circulation: Connect a monitor or defibrillator, establish an IV or IO, record a 12-lead ECG, monitor blood pressure and conduct appropriate lab studies (potassium, glucose, ionized calcium, magnesium, blood gas, toxicology screen).

STEP 2

Reassess bradycardia and cardiopulmonary compromise

This step entails checking the patient to determine whether the interventions in step 1 have altered the bradycardia or cardiopulmonary compromise. Follow the procedures accordingly based on the answer to the question of whether step 1 has halted bradycardia:

No, Bradycardia/Cardiopulmonary compromise does not continue:Support the ABCs as needed, administer oxygen, conduct frequent reassessments and consult a pediatric cardiologist.

No, Bradycardia/Cardiopulmonary compromise continues:If the heart rate is less than 60 BPM and there are still indicators of poor perfusion proceed to Step 3.

STEP 3

CPR

Perform high quality CPR.

STEP 4

Reassess Rhythm

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STEP 5

Administer Medications

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STEP 6

Proceed to Pediatric Cardiac Arrest Algorithm

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