What is the first-line pharmacologic treatment for symptomatic bradycardia in PALS?

What is the first-line pharmacologic treatment for symptomatic bradycardia in PALS?

• A. Epinephrine 0.01 mg/kg IV
• B. Dopamine infusion
• C. Glucagon 0.03 mg/kg IV
• D. Atropine 0.02 mg/kg IV (min 0.1 mg, max 0.5 mg per dose)

Answer: (D)

Atropine is the first-line pharmacologic therapy for symptomatic bradycardia in PALS because it blocks muscarinic receptors, removing the parasympathetic “brake” on the heart. This increases automaticity of the SA node and improves AV nodal conduction, helping to raise the heart rate and restore perfusion. Give atropine IV or IO at 0.02 mg/kg, with a minimum dose of 0.1 mg and a maximum of 0.5 mg per dose. If there’s no adequate response, it can be repeated every 3–5 minutes; if bradycardia persists after repeat dosing, escalate to pacing or start an epinephrine infusion (0.01 mg/kg IV every 3–5 minutes) or a dopamine infusion as needed. In parallel, address any underlying cause, such as hypoxia, and continue CPR as indicated.

Atropine is the first-line pharmacologic therapy for symptomatic bradycardia in PALS because it blocks muscarinic receptors, removing the parasympathetic “brake” on the heart. This increases automaticity of the SA node and improves AV nodal conduction, helping to raise the heart rate and restore perfusion.

Give atropine IV or IO at 0.02 mg/kg, with a minimum dose of 0.1 mg and a maximum of 0.5 mg per dose. If there’s no adequate response, it can be repeated every 3–5 minutes; if bradycardia persists after repeat dosing, escalate to pacing or start an epinephrine infusion (0.01 mg/kg IV every 3–5 minutes) or a dopamine infusion as needed. In parallel, address any underlying cause, such as hypoxia, and continue CPR as indicated.