4-4 PEDIATRIC BRADYCARDIA

EMR - Emergency Medical Responder

1. Establish patient responsiveness. If cervical spine trauma is suspected, manually stabilize the spine.
2. Assess the patient’s airway of patency, protective reflexes and the possible need for advanced airway management. Look for signs of airway obstruction and if present proceed as per airway obstruction protocol.
3. Open the airway via chin lift or modified jaw thrust.
4. Suction as necessary
5. Consider placing an oropharyngeal or nasopharyngeal airway adjunct if the airway cannot be maintained with positioning and the patient is unconscious.
6. Assess patient breathing, including mental status rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
7. If signs of respiratory arrest or respiratory failure with inadequate breathing are present, assist ventilation using a BVM device with 100% oxygen, if available, and begin chest compressions if heart rate <60 beats per minute despite oxygenation and ventilation.
8. If breathing is adequate, place the child in a position of comfort and administer high-flow 100% oxygen as tolerated.
9. Assess circulation and perfusion.
10. Call for ALS intercept

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Assess patient breathing, including mental status, rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
2. Check blood glucose and if less than 60 mg/dL, refer to pediatric hypoglycemia protocol.
3. Apply ECG monitor & run strip (if trained, if time allows and after all other interventions are completed).
4. Initiate rapid transport and Contact MEDICAL CONTROL to request ALS intercept.

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Assess patient breathing, including rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
2. Establish vascular access and administer a 20 mL/kg NS bolus. If IV access unlikely or cannot be established within 2 attempts in a child less than 6, do not attempt further IV placement and begin transport.
3. Contact MEDICAL CONTROL to request ALS intercept, especially if no vascular access, and for further fluid orders if vascular access is established.

Intermediate - Perform/Confirm All Above Interventions

1. Evaluate for endotracheal intubation if trained to do so.
2. If signs of severe cardiopulmonary compromise, establish vascular access and administer NS at a TKO rate. If IV access unlikely or cannot be obtained in 2 attempts in a child less than 6, consider IO access.
3. If signs of severe cardiopulmonary compromise and pulse rate less than 60 despite airway management, administer epinephrine using the first available route as follows:
   1. 0.1 mg/kg of Epinephrine 1:1,000 solution via ET tube (max dose 10 mg)
   2. 0.01 mg/kg of 1:10,000 solution via IV/IO (max dose 1 mg)
   3. Repeat every 3 to 5 minutes until either the bradycardia or cardiopulmonary compromise resolves
   4. If signs of severe cardiopulmonary compromise and pulse rate less than 60 despite epinephrine, administer atropine at 0.02 mg IV, IO or via ET tube (minimum dose is 0.1 mg and max dose is 0.5 mg for a child or 1 mg for an adolescent). Repeat once after 3 to 5 minutes and the dose may be doubled.
4. Initiate transport and Contact MEDICAL CONTROL
5. If bradycardia persists despite airway management, epinephrine and atropine administration, consider external pacing

Paramedic - Perform/Confirm All Above Interventions