PALS Bradycardia With a Pulse 5 — Questions and Answers
Question 1: A 5-year-old receives atropine 0.02 mg/kg for symptomatic bradycardia. Five minutes later the HR is unchanged at 50 bpm. The maximum total atropine dose is:
- 0.5 mg total
- 1 mg total
- 0.04 mg/kg (max 1 mg in children) (Correct answer)
- 3 mg total
Correct answer: 0.04 mg/kg (max 1 mg in children)
PALS allows a repeat atropine dose of 0.02 mg/kg; the maximum total dose is 1 mg for children.
Question 2: A teenager is found bradycardic with a HR of 38 bpm after taking a calcium channel blocker overdose. Which treatment is most appropriate?
- Adenosine 6 mg IV push
- High-dose insulin euglycemic therapy and calcium chloride IV (Correct answer)
- Atropine 3 mg IV
- Amiodarone 5 mg/kg IV
Correct answer: High-dose insulin euglycemic therapy and calcium chloride IV
Calcium channel blocker overdose is treated with IV calcium (calcium chloride or gluconate) and high-dose insulin euglycemic therapy to restore cardiac function.
Question 3: During a code, a 7-year-old is bradycardic and unresponsive despite two doses of atropine and one dose of epinephrine. The team starts CPR. What compression-to-ventilation ratio is correct for a 2-rescuer pediatric CPR scenario (intubated)?
- 30:2
- 15:2
- Continuous compressions at 100–120/min with asynchronous ventilations at 1 breath every 2–3 seconds (Correct answer)
- 5:1
Correct answer: Continuous compressions at 100–120/min with asynchronous ventilations at 1 breath every 2–3 seconds
Once an advanced airway is in place for a child, CPR delivers continuous compressions at 100–120/min with asynchronous breaths at 1 per 2–3 seconds.
Question 4: A 6-month-old has a HR of 72 bpm with capillary refill of 4 seconds and poor feeding. What is the most likely cause of bradycardia in this age group?
- Athletic conditioning
- Hypoxia or respiratory compromise (Correct answer)
- Primary cardiac arrhythmia
- Medication overdose
Correct answer: Hypoxia or respiratory compromise
In infants, respiratory compromise and hypoxia are the most common causes of bradycardia; respiratory assessment is the priority.
Question 5: Which statement correctly describes the role of pacing in PALS bradycardia management?
- Transcutaneous pacing is first-line before drug therapy
- Pacing is indicated only after drugs fail and for patients with heart block or sinus node dysfunction (Correct answer)
- Transvenous pacing is the preferred initial pacing method in children
- Pacing is contraindicated in children under 8 years of age
Correct answer: Pacing is indicated only after drugs fail and for patients with heart block or sinus node dysfunction
Pacing is a secondary option in PALS, used when pharmacotherapy fails or for refractory heart block and sinus node dysfunction.
Question 6: A 4-year-old is bradycardic with a HR of 50 bpm and is cold to the touch with a core temperature of 30°C (86°F). Drug therapy has been ineffective. What is the priority intervention?
- Give a third dose of epinephrine
- Begin active rewarming and limit drug doses due to hypothermia (Correct answer)
- Proceed directly to defibrillation
- Administer amiodarone 5 mg/kg
Correct answer: Begin active rewarming and limit drug doses due to hypothermia
In hypothermia, rewarming is the definitive treatment; drugs are less effective at low temperatures and can accumulate to toxic levels if repeated.
Question 7: During post-resuscitation care of a child with bradycardia, continuous epinephrine infusion is ordered. What rate range is used in PALS?
- 0.001–0.01 mcg/kg/min
- 0.01–1 mcg/kg/min (Correct answer)
- 5–20 mcg/kg/min
- 1–10 mg/kg/hr
Correct answer: 0.01–1 mcg/kg/min
The PALS epinephrine infusion dose range for bradycardia and poor perfusion is 0.01–1 mcg/kg/min, titrated to effect.
PALS Bradycardia With a Pulse 5
A 5-year-old receives atropine 0.02 mg/kg for symptomatic bradycardia.
Five minutes later the HR is unchanged at 50 bpm.
The maximum total atropine dose is: