Epinephrine for Bradycardia in PALS but not ACLS

jadelpn, LPN, EMT-B · Jan 1, 2015

I really do not know the answer to this, however, I can take a stab at it--perhaps because in pediatrics, the main reason one goes into cardiac arrest has to do with respiratory distress (unless there is unknown cardiac issues). Additionally, peds have a faster and more profound reaction to epi than adults--and atropine given to children can be risky.

Medscape: Medscape Access

Esme12, ASN, BSN, RN · Jan 1, 2015

An immature nervous system. Also children...babies lack the ability to increase the strength of the contraction to increase cardiac output...they only increase heart rate. So.....to increase perfusion and cardiac output thereby increasing end organ perfusion Epi is used.

In the face of decreased perfusion, epinephrine is used to produce alpha-adrenergic
vasoconstriction which increases systemic vascular resistance. This results in
increased aortic diastolic pressure, improving coronary and cerebral perfusion

http://www.medicine.virginia.edu/clinical/departments/pediatrics/education/pharm-news/2006-2010/201007.pdf

Anastasiak · Jan 2, 2015

Hi, thanks for the responses. Very interesting. Your responses have been helpful. I also read that stressed neonates quickly deplete their own stores of catacholamines so epinephrine is given first to elevate the heart rate.

NicuGal, MSN, RN · Jan 4, 2015

We pretty much only use Epi. On rare occasion, usually with an older kid do we use atropine. You can also use Epi down the OET which comes in handy in the DR when there is no access!