PALS MC Pediatric Bradycardia Leading to Cardiac Arrest

Pediatric Bradycardia Leading to Cardiac Arrest

A 6-month-old infant presents with profound lethargy and a heart rate of 50 bpm. The infant has weak central pulses and cyanosis around the lips and extremities. Their skin is cool and mottled, with signs of poor perfusion. The infant is hypotensive, and despite attempts to stimulate them, their condition rapidly deteriorates into cardiac arrest, necessitating immediate resuscitation efforts, including chest compressions and the administration of epinephrine.

Consider what typically causes bradycardia in infants and how to address it.

A 6-month-old presents with lethargy, a heart rate of 50 bpm, and poor perfusion. What is your first action?

Perform endotracheal intubation.

Provide bag-mask ventilation with 100% oxygen.

Administer atropine 0.02 mg/kg IV/IO.

Begin chest compressions immediately.

What action is taken for bradycardia unresponsive to initial interventions?

After 30 seconds of effective ventilation, the heart rate remains below 60 bpm. What is your next step?

Continue bag-mask ventilation for another minute.

Administer epinephrine 0.01 mg/kg IV/IO.

Place the child on a cardiac monitor.

Begin chest compressions.

Consider the ratio for 2-rescuer CPR without an advanced airway.

You start CPR. What is the appropriate compression-to-ventilation ratio without an advanced airway in place?

30:2

10:1

3:1

15:2

What is the first-line drug for pediatric bradycardia?

The child remains bradycardic despite chest compressions and ventilation. What is your next action?

Administer epinephrine 0.01 mg/kg IV/IO.

Administer atropine 0.02 mg/kg IV/IO.

Intubate the child immediately.

Increase oxygen concentration.

Consider the role of vagal tone in pediatric bradycardia.

After administering epinephrine, the heart rate improves but perfusion remains poor. What additional intervention should you consider?

Administer a 20 mL/kg fluid bolus.

Initiate a dopamine infusion.

Perform synchronized cardioversion.

Administer atropine 0.02 mg/kg IV/IO.

What interventions are recommended for asystole in pediatric patients?

The child’s rhythm changes to asystole. What is your immediate next action?

Continue chest compressions and administer epinephrine.

Defibrillate at 2 J/kg.

Administer atropine.

Intubate the child immediately.

What intervention corrects hypoxia in resuscitation?

During resuscitation, you identify hypoxia as the reversible cause. What action should you take?

Ensure effective ventilation with 100% oxygen.

Perform needle decompression.

Administer bicarbonate.

Administer a fluid bolus.

What is the primary goal after achieving ROSC?

ROSC is achieved. What is the next priority in post-resuscitation care?

Discontinue all resuscitation medications.

Initiate physical therapy immediately.

Administer a second dose of epinephrine.

Optimize oxygenation and ventilation.

What temperature range is ideal for minimizing neurological injury?

What is the target temperature management (TTM) strategy post-ROSC?

Maintain normothermia (36-37.5°C).

Allow for mild hyperthermia.

Avoid any temperature intervention.

Induce mild hypothermia (32-34°C).

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