History:

 

• Past medical history
• Medications (maternal/infant)
• Foreign body exposure/swallowed
• Respiratory distress/arrest
• Infection
  • Croup
  • Epiglottitis
• Apnea
• Possible toxic/poison exposure
• Congenital heart disease

 

Significant findings:

 

• Decreased heart rate
• Delayed capillary refill/cyanosis
• Mottled, cool skin
• Hypotension
• Respiratory difficulty
• Altered level of consciousness

 

Differential:

 

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

 

 Treatment:

 

• Administer Oxygen and hyperventilate patient approximately 2 min

 

• 12-Lead EKG

 

• Initiate IV/IO

 

Improving ?

 

• Yes

 

• • Continue to monitor and reassess

 

• No

 

HR < 60 with signs of poor perfusion ?

 

• • Refer to Team Approach CPR

 

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

 

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

 

• • Consider 10% Dextrose (D10) 5 mL/kg IV or Normal Saline 20 mL/kg IV; max 60 mL/kg or 1,000 mL

 

• • 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.
• The majority of pediatric arrests are due to airway problems.  Search for and treat contributing factors (H's and T's).
• NRP
• Most maternal medications pass through breast milk to the infant.  Consider Naloxone (Narcan) 0.1 mg/kg IV/IO; max 2 mg.
• Hypoglycemia, severe dehydration and narcotic effects may produce bradycardia.

 

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)