PALS Bradycardia
In adults, bradycardia is usually a heart problem. In children it is usually a breathing problem: hypoxia slows the heart. That difference shapes the paediatric bradycardia algorithm taught on the PALS course.
The pathway
Support airway and breathing with oxygen, monitor → if the heart rate stays below 60 with poor perfusion despite oxygenation and ventilation, start CPR → adrenaline → consider atropine for increased vagal tone or primary AV block → consider pacing and treat the cause.
Most paediatric bradycardia improves once hypoxia is corrected. Open the airway, give oxygen and support ventilation — see respiratory failure.
If the heart rate stays below 60 a minute with signs of poor perfusion despite effective oxygenation and ventilation, start chest compressions. This is one of the key differences from adults — see infant and child BLS.
Doses are by weight — see PALS drugs.
Considered for bradycardia due to complete heart block or sinus node dysfunction, with expert help — see electrical therapy.
Hypoxia, hypothermia, raised intracranial pressure, heart block, toxins and drugs. If the pulse is lost, move to the cardiac arrest algorithm. The adult version is quite different — compare the ACLS bradycardia algorithm.
This guide summarises what the PALS course teaches, for education only. It is not a clinical protocol: follow the current American Heart Association guidelines, linked below, and your institution’s paediatric policies.
Other life support and first aid courses: BLS Course · ACLS Course · First Aid Course · Training calendar
Hypoxia.
When the heart rate is below 60 with poor perfusion despite effective oxygenation and ventilation.
Adrenaline; atropine for increased vagal tone or primary AV block.
It may be considered for heart block or sinus node dysfunction, with expert help.
In children, oxygenation comes first and CPR is started for a slow rate with poor perfusion.
Paediatric emergencies are learned by doing. Safety First Medical Services is an American Heart Association training centre on Al Reem Island, Abu Dhabi, with HeartCode, classroom and on-site PALS and a two-year AHA PALS Provider eCard.
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What we teach follows the awarding body and the UAE health authorities. For the definitive position on a course or licensing question, these are the places to check.
Last reviewed by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.