Tx for bradycardic adults vs. peds

[granitendirt]

I'm taking some practice quizzes to prepare for the NREMT and had seemingly conflicting answers provided for two similar questions.

One of the questions asked what I'd do for a bradycardic 61 year old in respiratory arrest. The correct answer was to assist ventilations.

Another question on the same quiz asked what I'd do for an unresponsive, bradycardic (20 bpm) 6 month old. The correct answer was to begin chest compressions, although the accompanying explanatory text said that if the heart rate was 60-80, you'd just be assisting ventilations.

There was really no more information given - the only real difference appears to be the patient's age (although it didn't give the heart rate in the first question, just said bradycardic).

If anyone could help direct me to the proper way to determine when to start ventilations vs. compressions with respiratory arrest and bradycardia, it would be much appreciated!

 

[Christopher]

I'm taking some practice quizzes to prepare for the NREMT and had seemingly conflicting answers provided for two similar questions.

One of the questions asked what I'd do for a bradycardic 61 year old in respiratory arrest. The correct answer was to assist ventilations.

Another question on the same quiz asked what I'd do for an unresponsive, bradycardic (20 bpm) 6 month old. The correct answer was to begin chest compressions, although the accompanying explanatory text said that if the heart rate was 60-80, you'd just be assisting ventilations.

There was really no more information given - the only real difference appears to be the patient's age (although it didn't give the heart rate in the first question, just said bradycardic).

If anyone could help direct me to the proper way to determine when to start ventilations vs. compressions with respiratory arrest and bradycardia, it would be much appreciated!

This is correct.

In the adult case you have an implied palpable pulse which I imagine is "sufficient" for perfusion, just without adequate ventilations. A good scenario for this would be a 61yo who took one too many morphine pills. They may have a good pulse and blood pressure but be breathing twice a minute.

That patient would get assisted ventilations, and depending on where you're an EMT some intranasal naloxone.

In the pediatric case you have an insufficient pulse to support perfusion due to it being <60 bpm. In this case you need to start chest compressions to assist the pulse. You're correct that your next course of action would be to assist ventilations as well.

In adults we do chest compressions when they're pulseless, yet in kids we do chest compressions when their pulse is inadequate (defined as <60 bpm).

Does this make sense?

 

[granitendirt]

Yes that is very helpful, thank you for clarifying!