For a pediatric patient with a heart rate less than 60 bpm, which action should be initiated first?

• A. Administer Atropine
• B. Obtain IV Access
• C. Start CPR
• D. Provide Bag-Valve Mask Ventilation

Answer: (C)

When a pediatric patient has a heart rate below 60 beats per minute with signs of poor perfusion, the situation is treated as cardiac arrest and the first action is to start high-quality CPR immediately. Restoring circulation is the priority because brain and vital organs are not receiving enough oxygen, and chest compressions provide the essential blood flow needed while you address the underlying cause.

Begin chest compressions right away, aiming for a rate of about 100–120 compressions per minute with sufficient depth for the child and allowing full chest recoil. Ventilations should be delivered as part of the CPR cycle (for a single rescuer, typically 30 compressions to 2 breaths; for two rescuers, 15:2). After CPR has started, you can pursue IV/IO access and follow the protocol for medications (such as epinephrine) as indicated. Atropine is not the immediate first step in this arrest scenario, and airway ventilation alone without compressions does not correct the critically low perfusion.