Bradycardia with a pulse

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Focus on rapid and early BLS airway and ventilation tools. Intubation may not be the best option for these patients. 
□ Pediatric pads should be used in children < 25 Kg. 
□ If bradycardia is not corrected rapidly and the patient appears poorly perfused, start CPR.		□ HR < 60 min with hypotension 
□ Acute altered LOC 
□ CHF 
□ Seizure, syncope, or shock secondary to bradycardia. 
□ Altered LOC 
□ Shock / Hypotension 
□ Syncope		□ Respiratory distress 
□ Hyperkalemia
□ Respiratory obstruction 
□ Beta blocker / Digoxin 
□ Calcium Channel Blocker 
□ Organophosphate 
□ Hypovolemia 
□ Hypothermia 
□ Hypoxia 
□ Infection / Sepsis 
□ Medication or Toxin 
□ Trauma 
□ Arrhythmia / Acute MI

Clinical Management Options

EMT-B
• Oxygen PRN titrated to SpO2 92%-96% 
• Basic airway management 
• If pediatric and HR < 60 with poor perfusion despite oxygenation & ventilation, begin Pit Crew CPR 
Paramedic
• Vascular access 
• Obtain EKG
• Place pads on the patient
• Monitor ETCO2
• Consider fluid bolus
• Provide atropine or push dose epinephrine for bradycardia with hypotension
• Provide transcutaneous pacing for hypotensive patients who do not improve with atropine or epinephrine
• Provide sedation and pain control if transcutaneous pacing
• Consider hyperkalemia
• Treat hyperkalemia with calcium, sodium bicarb, albuterol
Consult Online Medical Control as Needed

Pearls

  • The use of lidocaine or amiodarone in heart block can worsen bradycardia and lead to asystole and death. 
  • Treatment of bradycardia is based on the presence of symptoms. If asymptomatic, monitor only. 
  • The use of Atropine for bradycardia in the presence of an MI may worsen ischemia. 
  • Consider treatable causes for bradycardia (Beta blocker OD, Calcium channel blocker OD, etc.) – treat appropriately. 
  • If wide complex bradycardia, consider hyperkalemia.