Pediatric Bradycardia With a Pulse and Poor Perfusion Algorithm

This figure conveys the Pediatric Bradycardia With a Pulse and Poor Perfusion Algorithm. It includes a flowchart on the left and a table of related information to the bottom right. The flowchart consists of numbered boxes and hexagons linked together with arrows. It originates at the top with box number 1. This green box is titled, “Identify and treat underlying cause.” It is followed by five points:
  • Maintain patent airway; assist breathing as necessary.
  • Oxygen.
  • Cardiac monitor to identify rhythm; monitor blood pressure and oximetry.
  • I.O. or I.V. access.
  • 12-Lead ECG if available; don’t delay therapy.
From here, an arrow points downward to item 2, which is a red hexagon that asks, “Cardiopulmonary compromise.” It is followed by three points:
  • Hypotension.
  • Acutely altered mental status.
  • Signs of shock.
From here, the pathway branches. Following the “Yes” path, an arrow points down to box 3, which is blue. It states, “CPR if heart rate is less than 60 beats per minute with poor perfusion despite oxygenation and ventilation. It then leads to item 4. If the answer is “No,” an arrow points to the left and downward to box 4a, which is green. It contains four points:
  • Support ABCs.
  • Give oxygen.
  • Observe.
  • Consider expert consultation.
Going back to item 4, it is a red hexagon that asks, “Bradycardia persists?” If the answer is “No,” an arrow points to the left to green box 4a, just covered. If the answer is “Yes,” an arrow leads down to box 5. This green box contains four points: • Epinephrine.
  • Atropine for increased vagal tone or primary A.V. block.
  • Consider transthoracic pacing or transvenous pacing.
  • Treat underlying causes.
From here, an arrow points downward to box 6. This white box says, “If pulseless arrest develops, go to Cardiac Arrest Algorithm. The one-column table to the bottom right is titled “Doses or Details,” an it contains two topics. The first is “Epinephrine I.O. or I.V. dose.” Its related text instructs, “0.01 milligrams per kilogram (0.1 milliliter per kilogram of 1 to 10,000 concentration.) Repeat every 3 to 5 minutes. If I.O. or I.V. access is not available but an endotracheal (or E.T.) tube is in place, may give E.T. dose: 0.1 milligram per kilogram (0.1 milliliter per kilogram of 1 to 1000).” The second topic is “Atropine I.O. or I.V. dose.” Its text directs, “0.02 milligrams per kilogram. May repeat once. Minimum dose 0.1 milligrams and maximum single dose 0.5 milligrams. This figure is copyright 2015 by the American Heart Association.