PALS Bradycardia Algorithm

PALS Bradycardia Algorithm

1. Bradycardia is diagnosed by manual testing or heart rate monitor – Normal heart rates change 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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