Ped's Bradycardia

Question 1

Initial Impressions/Differential Diagnosis

Answer 1

• Foreign Body/Secretions/Aspiration
• Respiratory Distress/Failure
• Possible Toxic Exposure/Ingestion
• Medication (maternal or infant)
• Congenital Diseases
• Infection (croup, epiglottitis)
• Hypovolemia (dehydration)
• Hypothermia
• Hypoglycemia
• Trauma

Question 2

Presentation

Answer 2

HR <60 Causing:
- ALOC
- Hypotension
- Poor perfusion
- Shock (usually <50 BPM)

Question 3

Initial Actions

Answer 3

• Open airway
• Provide Supplemental O2 & PPV if needed
• FSBG analysis
• Search for reversible causes (see differentials above)
• IV/IO Access, Pulse ox, Cardiac monitor
• 12 lead ECG (Don’t delay initiating TX)

Question 4

If Apneic or Pulseless @ Anytime..

Answer 4

Cardiac Arrest AG

Question 5

If <28 Days Old..

Answer 5

Begin Compressions & Refer to the
Neonatal Resuscitation AG

Question 6

If <1 yr..

Answer 6

Begin Compressions & Refer to
Cardiac Arrest AG

Question 7

If >1 yr..

Answer 7

Best Choice:
- 1:10 Epi 0.01mg/kg (1mg MAX single dose)
*MAY repeat q 3-5 min

OR If Vagal In Origin/1st Degree Block:
- Atropine 0.02 mg/kg (0.1mg Min & 1mg MAX initial dose) Rapid Push
*MAY repeat q 3-5 min (3mg MAX total dose)

• Administer Fluid Challenge 20mL/kg (Assess for fluid overload)

Question 8

If Continued Bradycardia After Drug Administration..

Answer 8

• Start Compressions
• Administer another dose of Epi
• Consider Atropine or other underlying Causes/TX’s
• Continue Fluid Challenge (Do not overload)

Question 9

Where would we transport these Pts?

Answer 9

Banner Main & TMC, ensure to notify before hand!