Continue to treat hypoxia and shock vigorously with intubation, ventilation, and volume expansion. If these measures do not lead to rapid improvement, consider a bolus of epinephrine 10^g/kg IV followed by an epinephrine infusion. The starting dose of epinephrine for infusion is 0-05 micrograms/kg/min.
In the patient who has developed bradycardia from vagal stimulation during suctioning or tracheal intubation, volume expansion is unlikely to be needed but good ventilation should be ensured prior to giving atropine 0-02mg/kg IV (minimum dose 0-1 mg, maximum 2-0mg/dose). The drug counteracts excess vagal tone.
Small doses of atropine may produce paradoxical bradycardia therefore, the recommended dose is 0-02mg/kg, with a minimum dose of 0-1mg and a maximum single dose of 0-5 mg in a child and 1-0 mg in an adolescent. The dose may be repeated in 5 minutes, to a maximum total dose of 1-0 mg in a child and 2-0 mg in an adolescent. If intravenous/intraosseous access is not readily available, atropine (0-04mg/kg) may be administered tracheally, although absorption into the circulation may be unreliable. Seek expert toxicology help for the management of bradycardia caused by poisoning.
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