PALS Bradycardia With a Pulse 2 — Questions and Answers
Question 1: A 4-year-old has a heart rate of 68 bpm with poor perfusion. After ensuring airway and oxygenation, what is the next intervention if the child remains symptomatic?
- Administer adenosine 0.1 mg/kg IV
- Begin CPR immediately
- Give epinephrine 0.01 mg/kg IV/IO (Correct answer)
- Perform synchronized cardioversion
Correct answer: Give epinephrine 0.01 mg/kg IV/IO
If bradycardia with poor perfusion persists despite adequate oxygenation, epinephrine is the drug of choice in PALS.
Question 2: Which ECG finding is most commonly associated with symptomatic bradycardia in pediatric patients requiring PALS intervention?
- First-degree AV block
- Complete (third-degree) heart block (Correct answer)
- Right bundle branch block
- ST-segment elevation
Correct answer: Complete (third-degree) heart block
Complete (third-degree) heart block causes complete dissociation between atria and ventricles, producing severe bradycardia requiring intervention.
Question 3: A 7-year-old with known congenital heart disease presents with HR 48 bpm, altered consciousness, and hypotension. Oxygen has been applied. What should be done NEXT?
- Administer atropine 0.02 mg/kg IV (Correct answer)
- Observe and recheck in 5 minutes
- Perform immediate defibrillation
- Administer adenosine
Correct answer: Administer atropine 0.02 mg/kg IV
Atropine is the first-line drug for symptomatic bradycardia with a pulse when the rhythm is vagally mediated or AV block is suspected.
Question 4: What is the minimum single dose of atropine recommended in PALS to avoid paradoxical bradycardia?
- 0.01 mg/kg
- 0.1 mg (regardless of weight)
- 0.02 mg/kg with a minimum of 0.1 mg (Correct answer)
- 0.5 mg for all children
Correct answer: 0.02 mg/kg with a minimum of 0.1 mg
PALS recommends atropine 0.02 mg/kg with a minimum single dose of 0.1 mg to avoid paradoxical bradycardia from very small doses.
Question 5: During management of a bradycardic infant, the team achieves IV access. Atropine has been given twice without improvement. What is the next pharmacologic step?
- Give a third dose of atropine
- Administer epinephrine infusion (Correct answer)
- Give amiodarone 5 mg/kg
- Administer digoxin
Correct answer: Administer epinephrine infusion
If atropine fails to correct symptomatic bradycardia, epinephrine infusion (0.01–1 mcg/kg/min) is the next pharmacologic agent in PALS.
Question 6: A 6-year-old is bradycardic with a HR of 42 bpm and is unresponsive. A rhythm check shows sinus bradycardia. CPR is in progress. Which statement about CPR in this scenario is correct?
- CPR is contraindicated if a pulse is present
- CPR should be initiated when bradycardia causes hemodynamic compromise despite interventions (Correct answer)
- CPR rate for children is 80 compressions per minute
- CPR should only start when the HR drops below 30 bpm
Correct answer: CPR should be initiated when bradycardia causes hemodynamic compromise despite interventions
PALS guidelines state CPR should be started for bradycardia causing cardiopulmonary compromise that is unresponsive to initial interventions.
Question 7: Which of the following conditions is a reversible cause of bradycardia that should be specifically addressed in pediatric patients?
- Hyperthyroidism
- Hypernatremia
- Hypothermia (Correct answer)
- Hypertension
Correct answer: Hypothermia
Hypothermia is a reversible H cause of bradycardia; rewarming the patient can restore normal heart rate.
PALS Bradycardia With a Pulse 2
A 4-year-old has a heart rate of 68 bpm with poor perfusion.
After ensuring airway and oxygenation, what is the next intervention if the child remains symptomatic?