Pediatric Cardiac Arrest

 

History:

 

  • Estimated downtime
  • Medical history
  • Medications
  • Hypothermia
  • Possibility of foreign body
  • Events leading to arrest

 

Significant Findings:

 

  • Unresponsive
  • Pulseless
  • Apneic
  • No electrical activity on EKG
  • Ventricular fibrillation/ventricular tachycardia
  • No auscultated heart tones

 

Differential:

 

  • Respiratory failure
  • Foreign body
  • Infection
  • Hypovolemia (dehydration)
  • Congenital heart disease
  • Trauma
  • Hypothermia
  • Medication/toxin
  • Hypoglycemia

 

Criteria for Death/DNR ?

 

  • Yes

 

    • Withhold Resuscitation:

 

      • Rigor mortis and/or dependent lividity
      • Body decomposition
      • Asystole with extended/unknown down time
      • Decapitation
      • Incineration

 

 

 

  • Contact (Medical Control) or Coroner

 

Criteria for Death/DNR ?

 

  • No

 

 

 

 

    • Immediate continuous compressions

 

 

 

    • Cardiac monitor/AED

 

    • Treat correctable causes early

 

 

 

    • Place advanced airway and provide 8-10 breaths per minute

 

 

 

    • Attach resQpod

 

 

 

    • Initiate IV/IO

 

V-Fib/pulseless V-Tach ?

 

  • Yes

 

 

 

    • Defibrillate 2 joules/kg; all subsequent shocks at 4 joules/kg

 

 

 

Asystole/PEA ?

 

  • Yes

 

 

 

 

Return of spontaneous circulation ?

 

  • Yes

 

 

PEARLS:

 

  • Pediatric = 1 day to less than age 12, or less than 55 kg in ages 13-18.
  • Use Broselow tape for drug dosages.
  • The majority of pediatric arrests are due to airway problems, therefore airway is the most important intervention.  This should be accomplished immediately. Patient survival is often dependent on airway management success.
  • CPR 100-120 compressions per minute and at a depth of no less than 1/3 of anterior/posterior diameter of chest with interruptions of less than 5 seconds.
  • Rotate compressors and check rhythm every 2 minutes.
  • Monitor in paddles mode with metronome on.
  • Always confirm asystole in more than one lead.
  • Assign a team resuscitation leader and utilize checklist.
  • Minimize patient movement.
  • After an advanced airway is placed, rescuers no longer deliver "cycles" of CPR.
  • Continue Epinephrine until rhythm changes or physician directs otherwise.
  • Most maternal medications pass through breast milk to the infant. Consider Naloxone (Narcan) 0.1 mg/kg IV/IM; max 2 mg.
  • Hypoglycemia, severe dehydration, and narcotic effects may produce bradycardia.
  • In order to be successful in pediatric arrests, a cause must be identified and corrected.
  • Reassess and document endotracheal tube placement and EtCO2 frequently, after every move, and at transfer of care.
  • Upload call summary to "QI" upon completion of call.
  • Remove resQpod once a pulse is returned.

OLMC

Online Medical Control - Contact Medical Control

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NRP

National Registry Paramedic

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

NRP

National Registry Paramedic