PALS - Pediatric Advanced Life Support Bradycardia With a Pulse Questions and Answers — Questions and Answers
Question 1: An 8-month-old infant is found apneic with a brachial pulse of 45/min and signs of poor perfusion. Despite effective bag-mask ventilation with 100% oxygen, the heart rate remains 45/min and perfusion is poor. What is the most appropriate immediate action?
- Provide rescue breaths only and recheck the pulse in 2 minutes.
- Administer IV epinephrine 0.01 mg/kg.
- Attach an AED and wait for rhythm analysis.
- Begin high-quality chest compressions and continue assisted ventilations. (Correct answer)
Correct answer: Begin high-quality chest compressions and continue assisted ventilations.
The PALS algorithm states that if a child has a heart rate less than 60/min with signs of poor perfusion despite adequate oxygenation and ventilation, CPR should be initiated. This infant's heart rate is 45/min with poor perfusion, meeting the criteria to start chest compressions along with ventilations.
Question 2: A 4-year-old child presents with symptomatic bradycardia. After ensuring a patent airway and providing effective oxygenation and ventilation, the child's heart rate remains 55/min with hypotension. An IV is in place. Which medication is the most appropriate first-line pharmacologic intervention?
- Amiodarone 5 mg/kg IV
- Epinephrine 0.01 mg/kg IV (Correct answer)
- Adenosine 0.1 mg/kg IV
- Sodium Bicarbonate 1 mEq/kg IV
Correct answer: Epinephrine 0.01 mg/kg IV
For persistent symptomatic bradycardia in a pediatric patient that is unresponsive to airway, oxygenation, and ventilation support, epinephrine is a primary medication. The correct IV/IO dose is 0.01 mg/kg. Atropine is also a consideration, especially for bradycardia caused by increased vagal tone or AV block, but epinephrine is a key drug for most causes of persistent, severe bradycardia.
Question 3: Which of the following is considered the MOST common cause of bradycardia in infants and children?
- Hypoxia (Correct answer)
- Congenital heart block
- Drug overdose
- Hypothermia
Correct answer: Hypoxia
Unlike in adults, bradycardia in the pediatric population is most often a secondary event caused by hypoxia from respiratory failure or shock. This is why the initial steps of the PALS Bradycardia Algorithm always focus on establishing a patent airway, ensuring adequate oxygenation, and assisting ventilation.
Question 4: A 6-year-old with a known third-degree AV block develops symptomatic bradycardia with a heart rate of 50/min. The child is hypotensive and lethargic despite a patent airway and adequate breathing. According to the PALS algorithm, which medication should be administered FIRST?
- Epinephrine 0.01 mg/kg
- Dopamine infusion at 5 mcg/kg/min
- Atropine 0.02 mg/kg (Correct answer)
- Calcium Chloride 20 mg/kg
Correct answer: Atropine 0.02 mg/kg
The PALS algorithm specifically recommends considering atropine as the first-line medication for symptomatic bradycardia due to increased vagal tone or a primary AV block. Epinephrine would be appropriate if atropine is ineffective or if the cause of bradycardia is not related to AV block.
Question 5: You are managing a 5-year-old with persistent symptomatic bradycardia. Initial steps of supporting oxygenation and ventilation were ineffective. IV epinephrine and atropine have been administered without improvement. The child remains hypotensive with poor perfusion. Which of the following interventions should be considered next?
- Synchronized cardioversion
- Administering a fluid bolus of 20 mL/kg
- Transcutaneous pacing (Correct answer)
- Administering a dose of amiodarone
Correct answer: Transcutaneous pacing
When symptomatic bradycardia is refractory to pharmacologic interventions (epinephrine, atropine), the PALS algorithm directs the provider to consider transcutaneous pacing or an epinephrine/dopamine infusion. Synchronized cardioversion is for tachyarrhythmias, and amiodarone is an antiarrhythmic not indicated for bradycardia.
Question 6: What is the correct IV/IO dose of atropine for a pediatric patient with symptomatic bradycardia according to the PALS guidelines?
- 0.1 mg/kg, with no minimum dose
- 0.02 mg/kg, with a maximum single dose of 0.5 mg (Correct answer)
- 0.5 mg fixed dose, may repeat once
- 0.01 mg/kg, with a maximum total dose of 1 mg
Correct answer: 0.02 mg/kg, with a maximum single dose of 0.5 mg
The correct IV/IO dose for atropine in the PALS bradycardia algorithm is 0.02 mg/kg. It's important to also remember the minimum dose (0.1 mg) and the maximum single dose (0.5 mg), which can be repeated once.
PALS - Pediatric Advanced Life Support Bradycardia With a Pulse Questions and Answers
An 8-month-old infant is found apneic with a brachial pulse of 45/min and signs of poor perfusion.
Despite effective bag-mask ventilation with 100% oxygen, the heart rate remains 45/min and perfusion is poor.
What is the most appropriate immediate action?