You have a 7 day old with a pulse rate of 50. We would start CPR, but do we attach the defib? And if yes, do we also analyze? And if yes, why would we analyze? 

Or do we attach the defib in anticipation of a pre-arrest? 

Or do we withhold the defib until pulseless? 

The standard procedure is to apply electrodes to a patient who is not VSA, nor a STEMI. However, SWORBHP would support application of defibrillation pads in settings where the chance of a cardiac arrest with a shockable rhythm may occur (Please see Ask MAC from May 18, 2012). As mentioned in this older Ask MAC, there are financial costs associated with the use of pads. 

Regarding a 7-day old, who is bradycardic, they are less likely than an adult to deteriorate into a shockable rhythm. Therefore, SWORBHP Medical council suggests to initiate your resuscitation including chest compressions if there are signs of hemodynamic instability (use the pediatric assessment triangle: Appearance (Tone, gaze, etc.), Breathing (Nostril flare, retractions), Circulation (mottling, cyanosis etc), per current Heart and Stroke of Canada (which follows the AHA Guidelines) recommendations, in addition to airway management. If the electrodes do not stay in place due to CPR, or if your young pediatric patient has a history of an underlying cardiac condition that puts them at increased risk of a shockable rhythm, SWORBHP Medical Council would support the use of defibrillation pads as part of your resuscitation.  

BLS,Pediatrics

Bradycardia, Defibrillation Pads, Hemodynamic Instability, Pediatric, Pediatric Assessment Triangle, Shockable Rhythm

BLS PCS 3.4 Patient Assessment Standard