FIELD REFERENCE
Full criteria & treatment guidance
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.
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.
VISUAL FIELD REFERENCE
Pediatric bradycardia starts with breathing
Pediatric · ALS
Poor-perfusion branch. Use the separate adequate-perfusion pathway below when applicable.
Open airway and support breathing
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.
Still below 60/min despite oxygenation and ventilation
If heart rate remains below 60/min despite oxygenation and ventilation, begin CPR and obtain IV/IO access.
Epinephrine and base contact
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.
- Base contact is required. Atropine does not replace oxygenation and ventilation.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-P-045 · PR-110
UNDERSTAND THE CARE
Why response to ventilation belongs in the handoff
The pediatric bradycardia pathway puts airway and breathing support ahead of the escalation for a persistently slow rate with poor perfusion. Document the breathing assessment and what changes after effective support. Rate, pulse, pressure, skin signs and consciousness together describe whether the child remains compromised.
Applying the guidance
If the child continues to meet the escalation criteria, use the pediatric sequence and weight-based preparation. Keep the atropine bradycardia limits separate from poisoning doses and retain the base-order requirement for pacing. Reassessment should establish both the rhythm response and the circulation response.
Putting it together
Teaching example: after airway positioning and assisted ventilation, the rate changes but perfusion remains poor. Communicate the actual response and continue the appropriate branch rather than assuming that a better rate alone means stabilization.
Diagram text & teaching checkpoints
- Airway and ventilation
- Correct inadequate support.
- Perfusion
- Assess pulse, pressure and consciousness.
- Persistent compromise
- Use pediatric CPR/medication criteria.
- Medical direction
- Contact base and reassess response.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.