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Welcome to the lesson on Recognizing Bradycardia. In this video, we will discuss what bradycardia means and how to recognize it.

Bradycardia is defined as a heart rate that is lower than what is considered normal for a child’s age. Bradycardia in children and infants should be evaluated, but not all bradycardia needs to be medically managed. Intervention is required when bradycardia is symptomatic and compromises cardiovascular function. This commonly means that the heart is beating too slowly to maintain blood pressure, thereby causing shock, poor tissue perfusion, and/or a change in mental status.

Symptomatic bradycardia may cause a number of signs and symptoms including low blood pressure, pulmonary edema/congestion, abnormal rhythm, chest discomfort, shortness of breath, lightheadedness, confusion, and/or or syncope. Bradycardia most commonly becomes symptomatic when it is of new-onset for the individual, which means acute slowing of the heart rate.

The following are the kinds of bradycardia and what happens during the specific bradycardiac event:

Sinus Bradycardia - normal rhythm with slow rate
First Degree AV Block - PR interval is longer than 0.20 seconds
Type I Second Degree AV Block (or Mobitz I) - PR interval increases in length until QRS complex is dropped
Types II Second Degree AV Block (or Mobitz II) - PR interval is the same length with intermittently dropped QRS complex
Third Degree AV Block (or Complete) - PR interval and QRS complex are not coordinated with each other

This concludes our lesson on Recognizing Bradycardia. Next, we will review Responding to Bradycardia.

Welcome to the lesson on Responding to Bradycardia. In this video, we will discuss how to respond to bradycardiac events.

To respond to symptomatic bradycardia, check the heart rate to confirm abnormally low heart rate or a significant rate drop from previous normal.

Complete the ABC survey by checking airway, breathing, and circulation.

Check for signs and symptoms of shock and acute change in mental status.

Perform necessary CPR and administer epinephrine and atropine as indicated.

Evaluate success of drugs and consider transthoracic or transvenous pacing, especially if bradycardia is the result of a complete heart block or an abnormal sinus node function.

Seek consultation from an expert, if needed.

Remember that the primary goal of symptomatic bradycardia treatment is to make sure the heart is adequate perfusion. Treatment is not necessarily aimed at increasing the heart rate; treatment should continue until symptoms and signs resolve.

If the individual stops having a pulse, move to the Cardiac Arrest Protocol. Always consider the reversible causes of bradycardia in pediatrics and treat if possible.

For further details on responding to bradycardia in pediatrics, please refer to Table 15 and the Pediatric Bradycardia with Pulse/Poor Perfusional Algorithm (that is Figure 13) in your corresponding PALS manual.

This concludes our lesson on Responding to Bradycardia. Next, we will review Recognizing Tachycardia.