General Guidelines

Asystole

Bradycardia

PEA

V-Fib

THE KEY TO QUALITY PEDIATRIC CARE LIES IN THE REALIZATION THAT CHILDREN ARE NOT SMALL ADULTS. SCALED DOWN EQUIPMENT AND SMALLER DRUG DOSAGES ARE ONLY THE BEGINNING. PEDIATRICS REQUIRES A DIFFERENT APPROACH TO PATIENT CARE. THE FOLLOWING GUIDELINES SHOULD BE KEPT IN MIND WHEN TREATING PEDIATRICS

1. THE AGE RANGE IN PEDIATRICS CAN MAKE OBTAINING A HISTORY DIFFICULT BUT YOU SHOULD NEVER DISMISS THE CHILD’S HISTORY.
2. A RAPID CARDIOPULMONARY ASSESSMENT SHOULD BE PERFORMED ON ALL PATIENT’S ON INITIAL CONTACT AND AFTER EACH INTERVENTION.
3. CARDIAC ARREST IS SELDOM A SUDDEN EVENT. IT IS MOST OFTEN THE RESULTS OF A PROGRESSIVE DETERIORATION OF THE CIRCULATORY (SHOCK) AND RESPIRATORY (HYPOXIA) SYSTEMS.
4. HYPOXIA PRODUCES A REFLEX BRADYCARDIA IN CHILDREN. ANY CHANGE IN RESPIRATORY RATE SHOULD BE CHECKED FOR A CORRESPONDING CHANGE IN HEART RATE AND VICE - VERSA
5. AGGRESSIVE AIRWAY CONTROL AND VENTILATION SHOULD ALWAYS BE A TOP PRIORITY.
6. THE INTRAOSSEOUS ROUTE IS APPROVED FOR PATIENTS UNDER THE AGE OF SIX AFTER 3 ATTEPMTS OR 90 SECONDS OF ATTEMPTING A PERPHERAL IV LINE
7. IN CASE OF OBVIOUS DEATH, CPR SHOULD BE PERFORMED IF IT IS THE PARENTS WISHES. NEVER LEAVE THE PARENT WITH THE IMPRESSION THAT SOMETHING ELSE COULD HAVE BEEN DONE
8. NEVER FORGET YOU ACTUALLY HAVE TWO PATIENTS, THE CHILD AND THE PARENTS. TRY TO INVOLVE THE PARENTS AS MUCH AS POSSIBLE WITHOUT COMPROMISING THAT CARE.

ASYSTOLE

GUIDELINES FOR CARE

1. ASSURE ABC’S
2. START CPR AND CONTINUE
3. PULSE OXIMETRY
4. CARDIAC MONITOR, CONFIRM ASYSTOLE IN TWO LEADS
5. INTUBATE AND VENTILATE WITH 100% OXYGEN VIA BVM
6. INITIATE IV OR INTRAOSSEOUS LINE
7. EPINEPHRINE (FIRST DOSE)
1. ADMINISTER 0.01 MG/KG 1:10,000 I.V. OR I.O.
2. OR 0.1 MG/KG 1:1,000 ETT IF I.V. OR I.O. NOT AVAILABLE
8. EPINEPHRINE (SECOND DOSE)
1. ADMINISTER 0.1 MG/KG 1:1,000 AND REPEAT EVERY 3 TO 5 MINUTES
9. CONSIDER ATROPINE 0.02MG/KG IV/IO
10. TRANSPORT AS INDICATED

GUIDELINES FOR CARE

1. ASSURE ABC’S
2. PULSE OXIMETRY
3. IF HEART RATE IS <80 IN INFANT OR <60 IN A CHILD, WHO ARE SYMPTOMATIC, START CPR AND CONTINUE
4. CARDIAC MONITOR
5. INTUBATE AND VENTILATE WITH 100% OXYGEN VIA BVM
6. INITIATE I.V. OR I.O. LINE
7. ADMINISTER EPINEPHRINE AND REPEAT EVERY 3-5 MINUTES
1. ADMINISTER 0.01 MG/KG 1:10,000 I.V OR I.O.
2. OR 0.1 MG/KG 1:1,000 ETT IF I.V. OR I.O. NOT AVAILABLE
8. ADMINISTER ATROPINE 0.02 MG/KG AND REPEAT EVERY 3-5 MINUTES UNTIL A MAXIMUM OF 1 MG IN A CHILD OR 2 MG IN ADOLESCENTS.
9. TRANSPORT AS INDICATED
10. NOTE: IF ORGANOPHOSPHATE POISONING IS SUSPECTED AS BEING THE CAUSE OF THE BRADYCARDIA, ADMINISTER 0.05 MG/KG/DOSE IV (USUAL DOSE 1-5 MG), MAY BE REPEATED IN 15 MINUTES

GUIDELINES FOR CARE

1. ASSURE ABC’S
2. PULSE OXIMETRY
3. START CPR WITH 100% OXYGEN AND CONTINUE
4. CARDIAC MONITOR WHEN AVAILABLE
5. INTUBATE AND VENTILATE WITH CONTINUED 100% OXYGEN
6. INITIATE I.V. OR I.O. LINE
7. EPINEPHRINE (FIRST DOSE)
1. ADMINISTER 0.01 MG/KG 1:10,000 I.V. OR I.O.
2. OR 0.1 MG/KG 1:1,000 ETT
8. EPINEPHRINE (SECOND DOSE) 0.1 MG/KG 1:1,000 AND REPEAT EVERY 3-5 MINUTES

9. CONSIDER REVERSIBLE CAUSES AND TAKE THE APPROPRIATE ACTION

10. TRANSPORT AS INDICATED

GUIDELINES FOR CARE

1. ASSURE ABC’S
2. START CPR AND CONTINUE WITH 100% OXYGEN
3. MONITOR OR QUICK LOOK
4. DEFIBRILLATE UP TO THREE TIMES AS FOLLOWS, AS NEEDED:
1. (2 JOULES/KG)
2. (4 JOULES/KG)
3. (4 JOULES/KG)
5. PULSE OXIMETRY
6. INTUBATE AND CONTINUE VENTILATIONS WITH 100% OXYGEN
7. INITIATE I.V. OR INTRAOSSEOUS LINE
8. EPINEPHRINE (FIRST DOSE)
1. ADMINISTER 0.01 MG/KG 1:10,000 I.V. OR I.O.
2. OR 0.1 MG/KG 1:1,000 ETT
9. ADMINISTER 1 MG/KG LIDOCAINE AND REPEAT UP TO A MAXIMUM OF 3 MG/KG
10. EPINEPHRINE (SECOND DOSE)
1. ADMINISTER 0.1 MG/KG 1:1,000 AND REPEAT EVERY 3-5 MINUTES
11. ADMINISTER BRETYLIUM 5 MG/KG INITIALLY, REPEAT ONE TIME AT 10 MG/KG TO A MAXIMUM OF 15 MG/KG
12. TRANSPORT AS INDICATED

NOTE: REMEMBER DRUG, SHOCK, DRUG, SHOCK ROUTINE AT 4J/KG 30-60 SECONDS AFTER EACH MEDICATION ADMINISTRATION.