PEDS
Bradycardia
Algorithm
Symptomatic or deteriorating bradycardia:
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► High-flow oxygen by Mask or Nasal Cannula, assist with BVM as needed
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If pulse rate < 60/minute and unresponsive with signs of poor perfusion, initiate CPR.
Establish IV access
►20 mL/kg NS bolus, if signs of hypovolemia or dehydration suspected
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Base Hospital Contact
Or
If no evidence of hypovolemia
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►Epinephrine 0.01 mg/kg IV / IO (0.1 mg/mL)
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Base Hospital Contact
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Continued signs of poor perfusion
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Initiate Transcutaneous Pacing
Symptomatic bradycardia is a heart rate < 60 BPM and:
Signs of poor perfusion (hypotension, poor skin signs, ALOC, or SOB).
Deteriorating bradycardia is a heart rate < 60 BPM and:
Decreasing heart rate with time (ie: drop in rate from 60 to 50 over a few min., despite O2).
High flow O2 by mask or assist ventilations as necessary.
If pulse rate < 60/minute and unresponsive with signs of poor perfusion, initiate CPR.
BHO - Pacing, Versed, and Heart transplant patients (may not respond effectively to resuscitation drugs.)
1:10,000 = 0.1mg/mL
1:1000 = 1mg/mL