A 9-year-old child in sinus bradycardia should be treated with which medication?

• A. lidocaine
• B. amiodarone
• C. epinephrine
• D. naloxone hydrochloride

Answer: (C)

When a child with sinus bradycardia is hemodynamically unstable, the priority is to raise heart rate and improve perfusion quickly. Epinephrine fits this need because it has both beta-1 effects on the heart (increasing heart rate and contractility) and alpha-1 effects on the vessels (increasing systemic vascular resistance and blood pressure). This combination helps restore coronary and cerebral perfusion rapidly, which is essential in a critical bradycardic state. It can be given IV or IO and can be used as a bolus or as an infusion depending on the clinical scenario.

Lidocaine and amiodarone are antiarrhythmics aimed at treating ventricular tachyarrhythmias or certain unstable rhythms, not the primary issue of sinus bradycardia. Naloxone reverses opioid effects and would be used when overdose is suspected, not for typical sinus bradycardia. In stable cases of bradycardia, atropine is often considered first, with epinephrine added if there is poor perfusion or if atropine does not adequately improve the situation.