Pediatrics

Bradycardia

Diagnosis

Age · HR

  • < 30 days · < 100
  • ≥ 30 days < 1 yr · < 80
  • ≥ 1 yr · < 60

Diagnosis

Age · HR

  • < 30 days · < 100
  • ≥ 30 days < 1 yr · < 80
  • ≥ 1 yr · < 60

  1. UNSTABLE: Hypotensive, pulseless, or poor perfusion

    Start chest compressions, go to CARDIAC ARREST

    • Epinephrine 10 MICROgrams/kg IV
    • Confirm NSR. If heart block or slow junction/ventricular, call Intraoperative Electrophysiology
    • Call for transcutaneous pacer (go to INSTRUCTIONS FOR PACING and start when available)
    • Consider ECMO

  2. STABLE: NOT hypotensive, pulseless, or poor perfusion

    Treat underlying etiology:

    • If hypoxia (common): Increase O2 to 100%, ensure ventilation, and go to HYPOXIA
    • If vagal: Atropine 0.01-0.02 mg/kg IV
    • If Surgical Stimulation: Stop stimulation and if laparoscopy, desufflate
    • If Ca-Channel Blocker Overdose: Calcium chloride 10-20 mg/kg IV or Calcium gluconate 50 mg/kg IV. If ineffective, Glucagon as dosed below
    • If Beta-Blocker Overdose: Glucagon 50 MICROgrams/kg IV, then 0.07 mg/kg/hour IV infusion (MAX 5 mg/hr) and check blood sugar
    • 0.01-0.02 mg/kg IV
    • 10-20 mg/kg IV
    • 50 mg/kg IV
    • 50 MICROgrams/kg IV
    • Then infusion 0.07 mg/kg/hour IV, MAX 5 mg/hr

  3. Crisis Management (If Severe)

    Notify surgeon, call for help and code cart

  4. Call for Transesophageal Echocardiography

  5. Start chest compressions

  6. Give epinephrine 10 MICROgrams/kg IV/IO

  7. If cardiac arrest, go to CARDIAC ARREST

  8. Consider ECMO

Patient weight

Between 0.5 kg and 120 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.