History:

 

• Respiratory arrest
• Cardiac arrest

 

Significant Findings:

 

• Return of pulse

 

Differential:

 

• Address specific differentials associated with the original dysrhythmia

 

Treatment:

 

• Continue ventilator support
• supplemental O2 to maintain SPO2 above 94%
• EtCO2 ideally 35-45
• RR <12
• DO NOT HYPERVENTILATE

• 12-Lead EKG

• Place 2nd IV/IO

 

Persistent arrhythmia (arrhythmias are common and usually resolve themselves after ROSC) ?

 

• Yes

 

• • See appropriate protocol

 

• No

 

Hypotension ?

 

• Yes

 

• • Consider Normal Saline 20 mL/kg IV/IO; max 60 mL/kg or 1,000 mL

 

• • OLMC: If still hypotensive after fluid bolus consider Push Dose Epi 10 mcg (1 mL)

 

Hypoglycemia?

 

• Yes

 

• • Consider 10% Dextrose (D10) 5 mL/kg IV/IO; may repeat once if BGL still low

 

Bradycardia ?

 

• Yes

 

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

 

• • Consider Atropine 0.02 mg/kg (0.2 mL/kg) IV/IO, min dose 0.1 mg; max dose 0.5 mg; may repeat once in 5 min

 

• • Consider transcutaneous pacing (see PEARLS)

 

• • Notify receiving facility or contact Medical Control

 

PEARLS:

 

• Pediatric = 1 day to less than age 12, or less than 55 kg in ages 12-18.
• Use Handtevy for drug dosages and color chart.

• If patient remains hypotensive after initial Normal Saline bolus, contact (Medical Control) for additional fluid.

 

 

Transcutaneous pacing table:

 

Age           Rate (bpm)         Systolic BP (mmHg)

 

0-3 mo       120-150             85 (+/-25)

3-6 mo       120-130             90 (+/-30)

7-10 mo     120                     96 (+/-25)

11-18 mo   110-120          100 (+/-30)

19-35 mo   110-120          100 (+/-20)

3-4 yr          100-110          100 (+/-20)

5-6 yr          100                  100 (+/-15)

7-9 yr            90-100          105 (+/-15)

10-12 yr        80-90            115 (+/-20)

>12 yr            70-80            120 (+/-20)