# Pediatric bradycardia

Correct oxygenation and ventilation first; escalate persistent bradycardia with poor perfusion.

Population: Pediatric. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See the linked OCEMS source for revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/pediatric-bradycardia/
Official source: [SO-P-045 — Bradycardia - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-45%20Bradycardia%20peds.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- Base contact is required. Atropine does not replace oxygenation and ventilation.
- The minimum 0.1 mg and maximum 0.5 mg apply to the bradycardia indication; organophosphate poisoning has a separate atropine regimen.

## Source documents

- [SO-P-045 — Bradycardia - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-45%20Bradycardia%20peds.pdf)
- [PR-110 — Transcutaneous Pacing (TCP)](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/PR-110%20TCP%204-2025.pdf)

## Assess perfusion

- Look for altered mental status, hypotension, weak perfusion, or shock. Ensure the airway is open and rule out obstruction.
- Assist breathing when needed with oxygen and BVM. Monitor rhythm, pulse, BP, and oxygen saturation; preserve a rhythm strip.

## Heart rate below 60 with continued poor perfusion

- If heart rate remains below 60/min despite oxygenation and ventilation, begin CPR and obtain IV/IO access.
- Give epinephrine 0.01 mg/kg IV/IO using 0.1 mg/mL (0.1 mL/kg); may repeat every 3–5 minutes. Make base contact, pediatric-capable preferred.
- If base contact cannot be established, the order lists atropine 0.02 mg/kg IV/IO for persistent symptomatic bradycardia, increased vagal tone, or primary AV block: minimum 0.1 mg, maximum 0.5 mg per dose; may repeat once.

## Further support

- Continued poor perfusion may require base-ordered transcutaneous pacing. Use the appropriate pediatric pads/placement under PR-110.
- For suspected hypovolemia or dehydration, normal saline is 20 mL/kg IV/IO, maximum 250 mL per bolus; may repeat twice for three total boluses. Identify causes such as hypoxia, hypothermia, or medication effects.

## If perfusion is adequate

- Support ABCs and monitor closely. If room-air SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated.
- Obtain a 12-lead and assess the cause. Contact base for destination and ALS escort. Document the response to ventilation before and after each intervention.