PALS Megacode Scenario Simulations on Bradycardia

This megacode simulation focuses on bradycardia. You’ll engage in realistic scenarios to manage slow heart rates in pediatric patients. This training emphasizes quick recognition and intervention strategies, honing your skills in effective treatment. Through hands-on practice, you’ll learn to navigate critical decisions and enhance your proficiency in managing bradycardia emergencies. Prepare to tackle complex cases and refine your response techniques in a high-stakes environment.

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1

What is the most appropriate initial action?

A 6-year-old patient presents with a heart rate of 58 bpm and is lethargic but responsive.  The patient is normotensive.

Hint: When the patient does not exhibit cardiopulmonary compromise, supportive measures are recommended.
2

What should be prioritized?

During a bradycardia simulation, a 4-year-old shows signs of poor perfusion and a heart rate of 50 bpm.

Hint: Signs of poor perfusion are indicative of cardiopulmonary compromise.
3

What is the recommended dose of atropine for a child experiencing bradycardia with poor perfusion?

Hint: Remember, 0.01 mg/kg is the recommended dose for epinephrine.
4

What should be your immediate intervention if the child has no palpable pulse?

A 3-year-old child presents with a heart rate of 60 bpm and unresponsiveness.

Hint: In cases of unresponsiveness and no pulse, focus on maintaining circulation.
5

What is the next appropriate step?

A 6-year-old with bradycardia is stable after receiving atropine but shows persistent symptoms of poor perfusion.

Hint: Remember, there are two medications as part of the bradycardia algorithm.
6

After administering supplemental oxygen, there is no improvement. Which step is NOT required next?

A 3-year-old with a history of congenital heart disease presents with a heart rate of 50 bpm and shows signs of cyanosis.

Hint: Consider the intervention that delays care and does not change the course of action.
7

What is the most appropriate course of action to address bradycardia?

During a PALS simulation, a 6-year-old child with bradycardia and hypotension is found to be hypothermic.

Hint: Consider interventions after supplemental oxygen is given and chest compressions have been initiated.
8

What should be your priority?

A child presents with bradycardia following a suspected toxic ingestion.

Hint: Consider interventions not only for suspected toxic ingestion but also the bradycardia algorithm.
9

What should be your next step?

A 5-year-old with bradycardia is receiving appropriate treatment but continues to exhibit bradycardia due to hypothermia.

Hint: Hypothermia can lead to bradycardia, and warming the child can help normalize the heart rate.
10

What additional intervention might be necessary if the bradycardia is persistent?

A 4-year-old child with bradycardia is not improving after initial treatment.

Hint: Part of initial treatments includes fluid resuscitation and providing supplemental oxygen.

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