PALS Bradycardia Algorithm

1. Bradycardia is diagnosed by manual testing or heart rate monitor – Normal heart rates vary with age/size.

2. Consider possible causes…

3. … and treat immediately

Hypoxia – Administer oxygen
Acidosis – Treated with increased ventilation; use sodium bicarbonate carefully if needed
Hyperkalemia – Restore normal potassium level
Hypothermia – Rewarm slowly to avoid over-heating
Heart block – Consult pediatric cardiologist for possible administration of atropine, chronotropic drugs, and external pacemaker
Toxins/Overdoses – Supportive care; administer antidote if one is available
Trauma – Increase oxygen and ventilation; Avoid increased intracranial pressure by treating bradycardia aggressively in cases of head trauma

4. Establish airway and support breathing as needed.

5. Monitor heart rate/rhythm and blood pressure

6. Establish IV/IO Access

7. Hypotension?

Age Category	Age Range	Systolic Blood Pressure	Diastolic Blood Pressure	Abnormally Low Systolic Pressure
Neonate	1 Day	60-76	30-45	<60
Neonate	4 Days	67-84	35-53	<60
Infant	To 1 month	73-94	36-56	<70
Infant	1-3 months	78-103	44-65	<70
Infant	4-6 months	82-105	46-68	<70
Infant	7-12 months	67-104	20-60	<70 + (age in years x 2)
PreSchool	2-6 years	70-106	25-65	<70 + (age in years x 2)
School Age	7-14 years	79-115	38-78	<70 + (age in years x 2)
Adolescent	15-18 years	93-131	45-85	<90

8. If hypotensive,

Administer epinephrine 0.01 mg/kg
Repeat every 3-5 minutes as needed
Consider atropine 0.02 mg/kg (min dose = 0.1 mg; max dose = 0.5 mg); Repeat one time if needed
Consider external pacemaker