In pediatric bradycardia, what should be done if there is no response to epinephrine?
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In pediatric bradycardia, atropine should be administered if no response to epinephrine and only if vagal or cholinergic drug toxicity cause. Hypoxemia is the number one cause of bradycardia in the pediatric population. NOTE: Oxygenate and ventilate, if this fails give Epinephrine IV in a poorly perfusing patient.
Atropine may be repeated only once in pediatric bradycardia. Atropine dose is 0.02 mg/kg IV or IO, minimum dose of 0.1 mg and max single dose of 0.5 mg. Poor perfusion requires emergency intervention. Cap refill of over 2 seconds, hypotension, faint pulses, altered level of consciousness and cool skin can signify poor perfusion that requires life saving interventions.
Epinephrine 0.01mg/kg (1:10,000) or 0.1 ml/kg may be administered every 3 to 5 minutes IV or IO. External pacing can be considered. Transcutaneous pacing is painful and sedation should be considered. Adult size pacer pads are used if over 10 kg. Demand rate setting starts at 100 and MA is adjusted until capture. A pediatric resuscitation tape will be useful.
Remember to provide oxygen and ventilate, if heart rate less than 60 with poor perfusion then chest compressions should be initiated. Pediatric bradycardia is defined as a heart rate of less than a child's normal heart rate according to their age unless a highly trained athlete.
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