Bradycardia with a pulse (PALS)
Paediatric emergency management · Cardiology · Emergency
HR under 60/min with poor perfusion → act. Support the airway, give high-flow oxygen and effective ventilation, attach the monitor, obtain access. In children bradycardia is usually caused by hypoxia.
If poor perfusion persists after oxygenation and ventilation
- Start CPR if HR stays under 60/min with poor perfusion despite effective oxygenation and ventilation.
- Atropine is preferred for increased vagal tone or primary AV block.
- Consider transcutaneous or transvenous pacing for complete heart block unresponsive to drugs.
- Treat the underlying cause — correct hypoxia first.
Common questions
What is the first step in bradycardia with a pulse (pals)?
HR under 60/min with poor perfusion → act. Support the airway, give high-flow oxygen and effective ventilation, attach the monitor, obtain access. In children bradycardia is usually caused by hypoxia.
What drug doses are used in bradycardia with a pulse (pals)?
Adrenaline IV/IO: 0.01 mg/kg (0.1 mL/kg of 1:10,000) every 3–5 min. Atropine IV/IO: 0.02 mg/kg (min 0.1 mg, max 0.5 mg); may repeat once.
About this page
Compiled from standard paediatric references. Verify against a current formulary and your local protocol.
Spotted something wrong? Report an error on this page — corrections from clinicians are welcome and are reviewed before any change is published.
Last reviewed 2026-08-12.