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PALS Bradycardia Algorithm

18-PALS-Bradycardia-Algorithm

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

Age Category Age Range Normal Heart Rate
Newborn 0-3 months 80-205 per minute
Infant/Young child 4 months to 2 years 75-190 per minute
Child/School Age 2-10 years 60-140 per minute
Older child/ Adolescent Over 10 years 50-100 per minute

2. Consider possible causes…

  • Hypoxia
  • Acidosis
  • Hyperkalemia
  • Hypothermia
  • Heart block
  • Toxins/Overdoses
  • Trauma

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

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