What is the first drug of choice for acute symptomatic bradycardia in pediatric patients?

For acute symptomatic bradycardia in pediatric patients, atropine is the first drug of choice. This is because atropine is an anticholinergic agent that works by increasing heart rate through inhibition of the vagus nerve’s influence on the heart. It blocks the activity of acetylcholine at parasympathetic sites in smooth muscle and secretory glands, which leads to an increase in heart rate by enhancing conduction through the atrioventricular node and increasing the firing rate of the sinoatrial node.

In cases of bradycardia, the goal is to restore an adequate heart rate to ensure sufficient blood flow and oxygen delivery to tissues. Atropine is effective at rapidly reversing the bradycardic effects, particularly in cases of increased vagal tone or certain types of heart block, making it a critical first-line therapy in pediatric resuscitation protocols.

Other medications listed have different indications and timing for use in ACLS protocols, but they do not serve as the initial treatment for symptomatic bradycardia in children. For instance, vasopressin is not indicated for bradycardia and is typically used in situations of cardiac arrest or severe hypotension. Amiodarone is primarily used for treating certain dysrh