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:

 

• • • See COG 1.4 for criteria for death/withholding resuscitation

 

• OLMC: Contact (Medical Control) or Coroner

 

Criteria for Death/DNR ?

 

• No

 

• • Refer to Team Approach CPR

 

• • Immediate continuous compressions

 

• • Cardiac monitor/AED

 

• • Treat correctable causes early

 

• • Place advanced airway and provide 20-30 breaths per minute

 

• • Initiate IV/IO

 

V-Fib/pulseless V-Tach ?

 

• Yes

 

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

 

• • Epinephrine 0.01 mg/kg (0.1 mL/kg) IV/IO; may repeat every 3-5 min

 

• • Amiodarone (Cordarone) 5 mg/kg IV/IO; may repeat twice, not to exceed adult dose

 

Asystole/PEA ?

 

• Yes

 

• • Epinephrine 0.01 mg/kg (0.1 mL/kg) IV/IO; may repeat every 3-5 min

 

Return of spontaneous circulation ?

 

• Yes

 

• • See Post Resuscitation Protocol

 

PEARLS:

 

• Pediatric = 1 day to less than age 12, or less than 55 kg in ages 12-18.
• Use Handtevy 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.