Date Published

March 13, 2023

Updated For

ALS PCS Version ALS PCS Version 5.2


Question from an ACP role, For a pediatric patient who has a HR less than 60 with poor signs of perfusion (cyanosis/pale and apneic€¦..start chest compressions with airway and ventilations via BVM. The question is do we follow it up with epi? In the PALS algorithm it states to do CPR/ventilations, epi, atropine and consider pacing. This is covered under the newborn arrest directive however it is not covered under the adult/pediatric medical cardiac arrest. What does our base hospital want us to? Would it be appropriate to follow the PALS Bradycardia algorithm?


In a pediatric patient with a HR less than 60 with poor perfusion, you would treat them as if they are in cardiac arrest and initiate chest compressions with airway and ventilations via BVM, while implementing the Medical Cardiac Arrest Medical Directive, including administering epinephrine for ACP scope. However, you would not independently administer atropine nor start Transcutaneous Pacing. The Symptomatic Bradycardia Medical Directive is not indicated for those <18 years.

If your initial management is not successful or if you think that these extra measures would be beneficial for your patient, patch the BHP for medical direction outside of the Medical Directives.



ALS-PCS, BLS-PCS, Bradycardia, Pediatrics

Additional Resources

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