🧒 PALS Pediatric Bradycardia Management
UseUse in a child with symptomatic bradycardia to determine the next intervention and calculate epinephrine and …
SourceAHA 2025 Pediatric Bradycardia Algorithm
This-shift next steps
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Methodology · worked example, guidelines & full notes
The most common cause of pediatric bradycardia is hypoxia, so oxygenation and effective ventilation come first; CPR begins if HR < 60 with poor perfusion persists.
When to use
Use in a child with symptomatic bradycardia to determine the next intervention and calculate epinephrine and atropine doses.
How it works
HR < 60 with poor perfusion despite adequate oxygenation/ventilation → CPR + epinephrine 0.01 mg/kg (max 1 mg) IV/IO; atropine 0.02 mg/kg (min 0.1, max 0.5 mg) only for increased vagal tone or AV block.
Key points
- The most common cause of pediatric bradycardia is hypoxia, so oxygenation and effective ventilation come first; CPR begins if HR < 60 with poor perfusion persists.
- Epinephrine is the first-line drug for hypoxic or shock-related bradycardia; atropine is reserved for increased vagal tone or AV block.
- Consider pacing for AV block or sinus-node dysfunction, and always search for reversible causes (hypoxia, hypothermia, acidosis, electrolytes, toxins, raised ICP).
References
- [Guideline / primary source]AHA 2025 Pediatric Bradycardia Algorithm
- [Guideline / primary source]2025 AHA/AAP Pediatric Advanced Life Support guidelines (Part 8, PMID 41122885)
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Weight (to calculate doses) | 15 kg |
|---|---|
| Heart rate and perfusion | HR < 60 but perfusion adequate |
| Primary cause | Hypoxia predominant |
→ManagementMonitor + investigate
- Management：HR < 60 but perfusion adequate: support ABC, give oxygen, monitor, investigate the cause; observe closely, manage per the tier above if perfusion becomes poor
- Backup doses：Epinephrine 0.01 mg/kg (max 1 mg) = 0.15 mg; atropine (vagal/AV block) 0.02 mg/kg = 0.3 mg
- Basis：AHA 2025 Pediatric Bradycardia Algorithm
| Weight (to calculate doses) | 15 kg |
|---|---|
| Heart rate and perfusion | HR < 60 with poor perfusion (despite adequate oxygenation/ventilation) |
| Primary cause | Hypoxia predominant |
→ManagementCPR + epinephrine
- Priority：Secure airway/oxygenation/ventilation; if HR < 60 with poor perfusion persists → start CPR (compressions + ventilation) immediately
- Epinephrine：0.01 mg/kg IV/IO = 0.15 mg (1:10000, 0.1 mL/kg); first choice for hypoxic/shock bradycardia
- Atropine：This case is hypoxic; atropine is not first choice; prioritize correcting hypoxia + epinephrine
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using PALS Pediatric Bradycardia Management?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does PALS Pediatric Bradycardia Management upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is PALS Pediatric Bradycardia Management calculated in practice? Can you show a worked example?
- Inputs: Weight (to calculate doses) 15 kg, Heart rate and perfusion HR < 60 but perfusion adequate, Primary cause Hypoxia predominant → Result: Management Monitor + investigate（Management: HR < 60 but perfusion adequate: support ABC, give oxygen, monitor, investigate the cause; observe closely, manage per the tier above if perfusion becomes poor, Backup doses: Epinephrine 0.01 mg/kg (max 1 mg) = 0.15 mg; atropine (vagal/AV block) 0.02 mg/kg = 0.3 mg, Basis: AHA 2025 Pediatric Bradycardia Algorithm） Inputs: Weight (to calculate doses) 15 kg, Heart rate and perfusion HR < 60 with poor perfusion (despite adequate oxygenation/ventilation), Primary cause Hypoxia predominant → Result: Management CPR + epinephrine（Priority: Secure airway/oxygenation/ventilation; if HR < 60 with poor perfusion persists → start CPR (compressions + ventilation) immediately, Epinephrine: 0.01 mg/kg IV/IO = 0.15 mg (1:10000, 0.1 mL/kg); first choice for hypoxic/shock bradycardia, Atropine: This case is hypoxic; atropine is not first choice; prioritize correcting hypoxia + epinephrine）