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Recognition & Management of Bradycardia By Dr. Akshay
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Page 1: Recognition & management of bradycardia pediatrics AG

Recognition & Management of

Bradycardia

By Dr. Akshay

Page 2: Recognition & management of bradycardia pediatrics AG

Objectives

Describe when bradycardia requires immediate intervention.

Describe initial steps to stabilize a child with cardiopulmonary compromise.

Know when to start CPR in a child with bradycardia.

Manage a child as outlined in s Pediatric Bradycardia with Pulse & poor perfusion algorithm

Select appropriate medications for treatment of symptomatic bradycardia

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definition

Bradycardia is a heart rate that is slow in

comparison with a normal heart rate range for

the child's age & the level of activity.

Bradycardia is an ominous sign!

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Basic Anatomy and Physiology

The SA node

The AV node

Bundle of His

Right Bundle Branch

Left Bundle Branch

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Types

Primary Bradycardia

Secondary Bradycardia

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Recognition of Bradycardia

Bradycardia rapidly turns into cardiopulmonary

compromise.

– Hypotension

– Decreased level of consciousness

– Shock

– Poor-end organ perfusion

– Respiratory distress or failure

– Sudden collapse

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ECG characteristics

Heart rate Slow compared to the normal heart rate for age

P waves May or may not be visible

QRS complex Narrow or wide (depending on the origin of the

pacemaker &/or location of the injury to the

conduction system)

P wave &

QRS complex

May be unrelated (AV dissociation)

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What is the paper speed?

Normal paper speed 25

mm/sec

1 small square=0.04s

1 big square= 0.2secs

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How to calculate the heart rate?Find 2 adjacent R waves, count the number of big squares between

the R’s

Divide 300 by the number of big squares : this is your heart rate

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bradyarrhythmias

Bradycardia which is associated with rhythm

disturbance known as bradyarrhythmias.

Common are sinus bradycardia & AV block.

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Sinus bradycardia

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First degree heart block

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Reversible causes

Hypoxia

Hydrogen ion

(acidosis)

Hyperkalemia

Hypothermia

Heart Block

Toxins / poisonings /

drugs

Trauma

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