Date Published

March 6, 2013

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: Recently I had a call for a 2 year old anaphylaxis that I ended up treating with epi and ventolin. The patient was very short of breath and had a decreased LOC and ended up having to be ventilated. Eventually the patient came around with the epi and the bagging. This patient's heart rate was approx. 70/min. My questions is, are we still starting CPR on pediatrics with signs of poor perfusion with a heart rate of less than 60 or is this just for neonates?


 Thanks for your question. In your Paramedic Medical Directive Handbook which you have been issued, you will find in the CPR section the following information.

Pediatric CPR Guidelines: Compressions should be started in an infant or child with a palpable pulse less than 60/min and signs of poor perfusion. Compressions should be started in a neonate with a palpable pulse less than 60/min despite supplemental oxygen and ventilation every 30 seconds.

A copy of these handbooks can also be found on our website here:



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