PALS Bradycardia With a Pulse 3 — Questions and Answers
Question 1: A neonate presents with bradycardia and poor tone after birth. Supplemental oxygen does not improve the HR above 60 bpm. What action should be taken?
- Administer atropine 0.02 mg/kg
- Begin chest compressions (Correct answer)
- Apply a transcutaneous pacemaker
- Give adenosine 0.1 mg/kg
Correct answer: Begin chest compressions
In neonates, if HR remains below 60 bpm despite adequate ventilation and oxygenation, chest compressions should be started.
Question 2: Transcutaneous pacing is being considered for a 10-year-old with symptomatic bradycardia refractory to medications. Which statement is TRUE about transcutaneous pacing in children?
- It is contraindicated in children under 12 years old
- It should be used before drugs in conscious patients
- Adequate analgesia and sedation should be provided during pacing (Correct answer)
- It is only effective for ventricular rhythms
Correct answer: Adequate analgesia and sedation should be provided during pacing
Transcutaneous pacing is painful; sedation and analgesia are essential when using it in conscious pediatric patients.
Question 3: A 3-year-old with Down syndrome presents with bradycardia and signs of respiratory distress. Which initial step has the highest priority?
- Establishing IV access for atropine
- Providing high-flow oxygen and supporting ventilation (Correct answer)
- Applying a cardiac monitor only
- Performing a 12-lead ECG
Correct answer: Providing high-flow oxygen and supporting ventilation
In PALS, the primary intervention for symptomatic bradycardia is always airway and oxygenation before any pharmacologic therapy.
Question 4: Which dose of epinephrine is used via the IV/IO route for bradycardia in the PALS algorithm?
- 0.1 mg/kg (1:1,000 solution)
- 0.01 mg/kg (1:10,000 solution) (Correct answer)
- 0.1 mg flat dose for all children
- 0.001 mg/kg (1:100,000 solution)
Correct answer: 0.01 mg/kg (1:10,000 solution)
PALS recommends IV/IO epinephrine at 0.01 mg/kg using the 1:10,000 (0.1 mg/mL) solution for bradycardia.
Question 5: A school-age child on beta-blocker therapy for hypertension presents with bradycardia. Which drug may be particularly useful in this situation?
- Adenosine
- Calcium gluconate
- Glucagon (Correct answer)
- Magnesium sulfate
Correct answer: Glucagon
Glucagon can overcome the negative chronotropic effects of beta-blockers and is a useful antidote for beta-blocker toxicity-induced bradycardia.
Question 6: During a resuscitation, the team identifies the pediatric patient's bradycardia is caused by increased vagal tone from suctioning. Which drug is most appropriate?
- Epinephrine
- Amiodarone
- Atropine (Correct answer)
- Lidocaine
Correct answer: Atropine
Atropine is the drug of choice for vagally mediated bradycardia because it blocks parasympathetic (vagal) tone.
Question 7: After successful treatment of symptomatic bradycardia in a 5-year-old, which finding confirms adequate cardiac output has been restored?
- Heart rate above 60 bpm alone
- Normal capillary refill, improved mental status, and adequate blood pressure (Correct answer)
- Absence of ectopic beats on the monitor
- Resolution of ST changes on 12-lead ECG
Correct answer: Normal capillary refill, improved mental status, and adequate blood pressure
Restoration of adequate perfusion is confirmed by normal capillary refill time, improved mentation, and blood pressure within normal limits for age.
PALS Bradycardia With a Pulse 3
A neonate presents with bradycardia and poor tone after birth.
Supplemental oxygen does not improve the HR above 60 bpm.
What action should be taken?