A 4-year-old with near-drowning is being bagged via face mask with 100 percent oxygen. His heart rate is 48/min with poor peripheral perfusion and a BP of 68/38 mmHg. After 30 seconds of effective assisted ventilation with adequate oxygenation, the heart rate remains 46/min. What is the correct next action?

• A Continue ventilation and reassess in another 2 minutes
• B Defibrillate at 2 J/kg
• C Begin chest compressions and prepare IV epinephrine 0.01 mg/kg ✓
• D Administer atropine 0.02 mg/kg

Explanation

In the PALS bradycardia algorithm, a heart rate below 60/min with poor systemic perfusion that persists despite effective oxygenation and ventilation is an indication to start chest compressions, along with epinephrine 0.01 mg/kg IV or IO every 3 to 5 minutes. Atropine is reserved for bradycardia from suspected vagal excess or cholinergic toxicity, and defibrillation requires a shockable rhythm, which excludes both distractors.

Reference: PALS Provider Manual, American Heart Association, 2020 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.