Page 286 - PJ MED OPS Handbook 8th Ed

PALS Cardiac Arrest
Pediatric Cardiac Arrest Algorithm
1
CPR Quality
Start CPR
• Begin bag-mask ventilation and give oxygen • Push hard (≥⅓ of anteroposterior
• Attach monitor/defibrillator diameter of chest) and fast
(100-120/min) and allow complete
chest recoil
• Minimize interruptions in
compressions
Yes No
Rhythm
• Change compressor every
shockable? 2 minutes, or sooner if fatigued
• If no advanced airway, 15:2
2 9 compression-ventilation ratio
VF/pVT Asystole/PEA • If advanced airway, provide
continuous compressions and
give a breath every 2-3 seconds
Shock Energy for Defibrillation
3
Shock Epinephrine
• First shock 2 J/kg
ASAP
• Second shock 4 J/kg
4 10 • Subsequent shocks ≥4 J/kg,
maximum 10 J/kg or adult dose
CPR 2 min CPR 2 min
IV/IO access • IV/IO access Drug Therapy
• Epinephrine every 3-5 min
• Epinephrine IV/IO dose:
• Consider advanced
0.01 mg/kg (0.1 mL/kg of the
airway and capnography
0.1 mg/mL concentration).
No Max dose 1 mg.
Rhythm
Repeat every 3-5 minutes.
shockable?
If no IV/IO access, may give
endotracheal dose: 0.1 mg/kg
Yes
Yes Rhythm (0.1 mL/kg of the 1 mg/mL
shockable? concentration).
5 Shock • Amiodarone IV/IO dose:
5 mg/kg bolus during cardiac
arrest. May repeat up to
No
6 3 total doses for refractory
CPR 2 min VF/pulseless VT
or
• Epinephrine every 3-5 min
11 Lidocaine IV/IO dose:
• Consider advanced airway
CPR 2 min Initial: 1 mg/kg loading dose
Treat reversible causes Advanced Airway
Rhythm No • Endotracheal intubation or
supraglottic advanced airway
shockable?
• Waveform capnography or
No Rhythm Yes capnometry to confirm and
Yes monitor ET tube placement
shockable?
Reversible Causes
7 Shock
• Hypovolemia
8 • Hypoxia
• Hydrogen ion (acidosis)
CPR 2 min
• Hypoglycemia
• Amiodarone or lidocaine
• Hypo-/hyperkalemia
• Treat reversible causes
• Hypothermia
• Tension pneumothorax
• Tamponade, cardiac
• Toxins
12
• Thrombosis, pulmonary
• If no signs of return of spontaneous Go to 7. • Thrombosis, coronary
circulation (ROSC), go to 10
• If ROSC, go to Post–Cardiac Arrest
Care checklist
© 2020 American Heart Association
284 n Pararescue Medical Operations Handbook / 8th Edition