A 2-year-old child develops severe bradycardia at 45 per minute with poor perfusion despite effective bag-mask ventilation with 100% oxygen for 2 minutes. The FIRST-LINE drug indicated is:

• A Atropine 0.02 mg/kg IV
• B Amiodarone 5 mg/kg IV load
• C Adrenaline 0.01 mg/kg IV or intraosseous ✓
• D Adenosine 0.1 mg/kg rapid IV push

Explanation

Paediatric bradycardia with cardiopulmonary compromise persisting despite oxygenation and ventilation is treated with adrenaline 0.01 mg/kg (0.1 mL/kg of 1:10,000), repeatable every 3 to 5 minutes, because the commonest mechanism is hypoxic myocardial depression rather than cholinergic excess. Atropine is reserved for suspected increased vagal tone, for example from tracheal suctioning, or cholinergic poisoning, or high degree AV block. Amiodarone and adenosine treat tachyarrhythmias and would worsen the situation here.

Reference: AHA Guidelines for CPR and Emergency Cardiovascular Care, 2020 ed.

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Written and medically reviewed by the StethoPrep medical team.