Pediatric Bradycardia Algorithm

Last updated: March 21, 2021

Version control: Our ACLS, PALS & BLS courses follow 2020 American Heart Association® Guidelines for CPR and ECC. American Heart Association® guidelines are updated every five years. If you are reading this page after December 2025, please contact support@acls.net for an update. Version 2021.01.c

A pediatric patient with symptomatic bradycardia needs the possible causes identified and treated such as hypothermia, hypoxia, or medications. Always maintain a patent airway and apply oxygen for saturation of less than 94% or signs of respiratory distress. Place the patient on a cardiac monitor and monitor vital signs. Obtain IV access or IO if the patient is unstable and IV access is unattainable. Continue to monitor the patient and consider a cardiology consult.

If the patient is unstable and showing signs of poor perfusion such as altered level of consciousness, hypotension, or signs of shock, immediate treatment is required. Maintain a patent airway and apply oxygen as necessary. Place the patient on a cardiac monitor and check B/P and oximetry. If the patient continues to show signs of poor perfusion after oxygenation therapy and the heart rate decreases under 60 beats per minute, start CPR. If the patient remains bradycardic administer Epinephrine 0.01mg/kg IV/IO. This may be repeated every 3–5 minutes for bradycardia. Atropine 0.02 mg/kg IV/IO can be given if the patient has an increased vagal tone if they have 2nd or 3rd degree AV block.

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