🧒 PALS Pediatric Bradycardia Management
This tool applies the AHA PALS bradycardia algorithm, deciding between supportive care, CPR, epinephrine and atropine by heart rate, perfusion and cause, with weight-based doses.
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.
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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 IV/IO q3–5 min; 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
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 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) q3–5 min; first choice for hypoxic/shock bradycardia
- Atropine：This case is hypoxic; atropine is not first choice; prioritize correcting hypoxia + epinephrine
| Weight (to calculate doses) | 15 kg |
|---|---|
| Heart rate and perfusion | HR ≥ 60 |
| Primary cause | Increased vagal tone or AV block |
→ManagementNo emergency management
- Management：HR ≥ 60: not a bradycardia emergency, support ABC, monitor, investigate the cause
Frequently asked questions
- What is PALS Pediatric Bradycardia Management?
- This tool applies the AHA PALS bradycardia algorithm, deciding between supportive care, CPR, epinephrine and atropine by heart rate, perfusion and cause, with weight-based doses.
- How is PALS Pediatric Bradycardia Management calculated? What is the core formula?
- HR < 60 with poor perfusion despite adequate oxygenation/ventilation → CPR + epinephrine 0.01 mg/kg IV/IO q3–5 min; atropine 0.02 mg/kg (min 0.1, max 0.5 mg) only for increased vagal tone or AV block.
- When is PALS Pediatric Bradycardia Management used?
- Use in a child with symptomatic bradycardia to determine the next intervention and calculate epinephrine and atropine doses.
- What are the key clinical points for PALS Pediatric Bradycardia Management?
- 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).
- 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.
- 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 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) q3–5 min; first choice for hypoxic/shock bradycardia, Atropine: This case is hypoxic; atropine is not first choice; prioritize correcting hypoxia + epinephrine） Inputs: Weight (to calculate doses) 15 kg, Heart rate and perfusion HR ≥ 60, Primary cause Increased vagal tone or AV block → Result: Management No emergency management（Management: HR ≥ 60: not a bradycardia emergency, support ABC, monitor, investigate the cause）