Pediatric Bradycardia

 

History:

 

  • Past medical history
  • Medications (maternal/infant)
  • Foreign body exposure/swallowed
  • Respiratory distress/arrest
  • Infection
    • Croup
    • Epiglottitis
  • Apnea
  • Possible toxic/poison exposure
  • Congenital heart disease

 

Significant findings:

 

  • Decreased heart rate
  • Delayed capillary refill/cyanosis
  • Mottled, cool skin
  • Hypotension
  • Respiratory difficulty
  • Altered level of consciousness

 

Differential:

 

  • Respiratory failure
    • Foreign body
    • Infection
  • Hypovolemia (dehydration)
  • Congenital heart disease
  • Trauma
  • Tension pneumothorax
  • Hypothermia
  • Medication/toxin
  • Hypoglycemia
  • Acidosis

 

 Treatment:

 

  • Administer Oxygen and hyperventilate patient approximately 2 min

 

  • 12-Lead EKG

 

  • Initiate IV/IO

 

Improving ?

 

  • Yes

 

    • Continue to monitor and reassess

 

  • No

 

HR < 60 with signs of poor perfusion ?

 

 

 

 

 

 

    • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • Pediatric = 1 day to less than age 12, or less than 55 kg in ages 12-18.
  • Use Handtevy for drug dosages.
  • The majority of pediatric arrests are due to airway problems.  Search for and treat contributing factors (H's and T's).
  • NRP
  • Most maternal medications pass through breast milk to the infant.  Consider Naloxone (Narcan) 0.1 mg/kg IV/IO; max 2 mg.
  • Hypoglycemia, severe dehydration and narcotic effects may produce bradycardia.

 

Transcutaneous pacing table:

 

Age                Rate (bpm)                   Systolic BP (mmHg)

0-3 mo           120-150                            85 (+/-25)

3-6 mo           120-130                            90 (+/-30)

7-10 mo         120                                    96 (+/-25)

11-18 mo       110-120                          100 (+/-30)

19-35 mo       110-120                          100 (+/-20)

3-4 yr              100-110                          100 (+/-20)

5-6 yr              100                                  100 (+/-15)

7-9 yr                90-100                          105 (+/-15)

10-12 yr            80-90                            115 (+/-20)

>12 yr                70-80                            120 (+/-20)