If a pediatric patient has a heart rate less than 60 and signs of poor perfusion, what is the next step?

When a pediatric patient presents with a heart rate of less than 60 beats per minute accompanied by signs of poor perfusion, it indicates a critical situation that requires immediate intervention. In children, a heart rate below this threshold, especially in the presence of poor perfusion, suggests that the patient may be experiencing severe bradycardia or potentially cardiac arrest, both of which necessitate urgent action to restore adequate blood flow and oxygenation.

Starting CPR immediately is crucial because it helps maintain circulation to vital organs, increasing the chances of survival and recovery. CPR provides artificial respiration and circulation, which is vital when spontaneous heartbeats are inadequate to sustain life. In this scenario, other actions such as monitoring until help arrives or continuing rescue breaths may not be sufficient and could delay necessary resuscitation efforts. Checking the pulse every two minutes would also not provide timely intervention needed in such an emergent context.

Therefore, initiating CPR right away is the most appropriate step to take in order to improve the chances of a positive outcome for the patient.