Pediatric: Termination of Ventricular Rhythms

 

History:

 

  • Respiratory arrest
  • Cardiac arrest

 

Significant Findings:

 

  • Return of pulse

 

Differential:

 

  • Address specific differentials associated with the original dysrhythmia

 

Treatment:

 

 

 

  • Continue ventilator support
  • 100% Oxygen
  • EtCO2 ideally > 20
  • 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 10 mL/kg IV/IO; max 60 mL/kg or 1,000 mL

 

 

 

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

 

Hypoglycemia?

 

  • Yes

 

 

 

 

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

 

 

    • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • Pediatric = 1 day to less than age 12, or less than 55 kg in ages 13-18.
  • Use Broselow tape for drug dosages and color chart.

 

 

 

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

 

 

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NREMT-I

National Registry EMT-Intermediate

OLMC

Online Medical Control - Contact Medical Control

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

OLMC

Online Medical Control - Contact Medical Control