Page 50 - 2023 SMOG Digital

Cardiac

PEDIATRIC CARDIAC ARREST

Signs and Symptoms: START CPR Signs and Symptoms:
• Unresponsive, apneic, Universal Patient Care Guideline • Pulseless
pulseless O2 • Apneic
• Ventricular fibrillation or Monitor/Defibrillator • No electrical activity in at
ventricular tachycardia on least two ECG leads
EKG VF / pulseless VT Asystole / PEA (asystole)
• Electrical activity on monitor
YES Rhythm shockable? NO without pulses (PEA)
Shock Confirm in two leads • No heart tones
1 st Shock 2 J/kg,
2 nd Shock 4 J/kg,
Then >4 J/kg up to 10 J/kg
CPR 2 min
CPR 2 min
IV/IO access (IV Guideline)
IV/IO access (IV Guideline) Epinephrine (q3–5min)
Rhythm Shockable? NO Return of Spontaneous NO 0.01mg/kg (0.1mL/kg of
1:10,000) IV/IO
Circulation (ROSC)?
YES Consider advanced airway,
Shock 4 J/kg YES capnography, 12–20 breaths/
min (Airway Guideline)
CPR 2 min
ROSC at any time: Rhythm Shockable? YES
Epinephrine (q3–5min) go to:
0.01mg/kg (0.1mL/kg of Post-Cardiac Arrest Care NO
1:10,000) IV/IO Guideline
Consider advanced airway, CPR 2 min
capnography: 12–20 breaths/ Treat Reversible Causes
min (Airway Guideline) Reversible Causes:
• Hypovolemia
Rhythm Shockable? NO • Hypoxia NO Rhythm Shockable? YES
YES • Hypothermia
Shock >4 J/kg up to • Hypoglycemia Move to
10J/kg or Adult • Tension pneumothorax VF/pulseless VT side of guideline
CPR 2 min • • Tablets / toxin
Tamponade, cardiac
Amiodarone IV/IO Lidocaine IV/IO • Hydrogen ion (acidosis) CPR Rate of 100-120
5mg/kg bolus OR 1mg/kg loading dose • Hypo-/hyperkalemia Compressions/Min
May Repeat X 2 Then 20-50mcg/kg/min • Thrombus–cardiac
• Thrombus–pulmonary • One Rescuer = 30 to 2 Breaths
Treat Reversible Causes • Two Rescuer = 15 to 2 Breaths
Pearls:
• CPR Rate of 100–120/min 2 inches depth for children and 1 1/2 inches depth for infants of chest with complete chest recoil
• Reversible causes should be addressed as soon as possible.
• Epinephrine Endotracheal Dose: 0.1 mg/kg (0.1mL/kg of 1:1,000 vial)
• Consider discontinuation of efforts if:
o Asystole following trauma–especially blunt
o Prolonged downtimes >15min
o Prolonged code with no response >3 rounds of medications, 30min of resuscitation
o All patients should get a glucose check, at least 20ml/kg fluid bolus of NS, and ultimately
bilateral needle decompression (Trauma) before discontinuation of efforts
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