A 14-month-old infant is being resuscitated. The airway is secured with effective bag-mask ventilation and supplemental oxygen, yet she remains pale with weak peripheral pulses, capillary refill 4 seconds, HR 48/min, and BP 62/30 mmHg. There is no history of trauma or toxin exposure. What is the most appropriate next drug?
- A IV epinephrine 0.01 mg/kg ✓
- B IV atropine 0.02 mg/kg
- C IV calcium gluconate 100 mg/kg
- D IV sodium bicarbonate 1 mEq/kg
Correct answer: A. IV epinephrine 0.01 mg/kg
Explanation
In PALS, symptomatic bradycardia with cardiopulmonary compromise is managed first by ensuring oxygenation and ventilation; if bradycardia persists, IV or IO epinephrine 0.01 mg/kg is the first-line drug, repeated every 3 to 5 minutes. Atropine is reserved for bradycardia due to increased vagal tone, cholinergic toxicity, or AV block, none of which is suggested here. Calcium and bicarbonate are given only for specific indications such as hyperkalemia, documented hypocalcemia, or known metabolic acidosis.
Reference: Nelson Textbook of Pediatrics / AHA PALS Provider Manual, 21st / 2020 guidelines ed.
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Written and medically reviewed by the StethoPrep medical team.