3 - Algorithms

Question 1

What is cardiopulmonary compromise?

Answer 1

1. Acutely altered mental status
2. Signs of shock
3. Hypotension

Question 2

Pediatric assessment triangle consists of three things. What are those three?

Answer 2

• Appearance
• Work of breathing
• Circulation transfer

Question 3

If child is unresponsive/needs immediate intervention, what is your next step?

Answer 3

1. Shout for nearby help.
2. Activate emergency response system.

Question 4

Pediatric Cardiac Arrest Algorithm

After starting CPR, ECG shows PEA. What is your next step?

Answer 4

1. Epinephrine ASAP
2. Continue CPR for 2 minutes, consider advanced airway capnography
3. Epinephrine q 3-5 minutes
4. CPR for 2 minutes - Treat reversible causes

Question 5

Pediatric Cardiac Arrest Algorithm

After starting CPR, ECG shows VF. What is your next step?

Answer 5

1. Electrotherapy
2. Continue CPR for 2 minutes, consider advanced airway capnography, Epinephrine q 3-5 minutes
3. Electrotherapy
4. Continue CPR for 2 minutes, Epinephrine q 3-5 minutes
5. Electrotherapy
6. CPR for 2 minutes - Amiodarone or Lidocaine - Treat reversible causes

Question 6

Pediatric Cardiac Arrest Algorithm

Electrotherapy energy for defibrillation

Answer 6

First - 2 J/kg
Second - 4 J/kg
Subsequent ≥ 4 J/kg

Max 10 J/kg or adult dose

Question 7

Pediatric Cardiac Arrest Algorithm

Drug Therapy for defibrillation

Answer 7

1. Epinephrine - 0.01 mg/kg (0.1 mg max dose), q 3-5 min
2. Amiodarone - 5 mg/kg bolus during cardiac arrest; x3’s for refractory VF/pulseless VT

or Lidocaine (1 mg/kg)

Question 8

Pediatric Bradycardic Algorithm (with pulses)

• Bradycardic with a pulse < 60 bpm, persistent, stable
  
  • Drug Therapy

Answer 8

1. Epinephrine - 0.01 mg/kg; q3-5m IV/IO
2. Atropine - 0.02 mg per kilogram (minimum 0.1 mg and max SINGLE dose 0.5 mg)

Question 9

Pediatric Bradycardic Algorithm (with pulses)

• Bradycardic with a pulse < 60 bpm,
  
  • underlying causes

Answer 9

Hypothermia
Hypoxia
Medications

Question 10

Pediatric Tachycardic Algorithm (with pulses)

• Tachycardic with a pulse, persistent, unstable
  
  • Infant Rate
  • Child rate

Answer 10

1. ≥ 220/min (infant)
2. ≥ 180/min (child)

Question 11

Pediatric Tachycardic Algorithm (with pulses)

• Tachycardic with a pulse, persistent, unstable
  
  • Electro-Therapy Dosages

Answer 11

1^st Synch Cardioversion @ 0.5-1 J/kg

2^nd+ Synch Cardioversion @ 2 J/kg

Question 12

Pediatric Tachycardic Algorithm (with pulses)

• Tachycardic with a pulse, persistent, unstable
  
  • Drug Therapy

Narrow Complex - Tachycardic with cardiopulmonary compromise

Answer 12

Adenosine - 0.1 mg/kg RVIP (max 6 mg); q @ 0.2 mg/kg (max 12 mg)

Question 13

Pediatric Tachycardic Algorithm (with pulses)

• Tachycardic with a pulse, persistent, unstable
  
  • Drug Therapy

Wide Complex - Tachycardic WITHOUT cardiopulmonary compromise

Answer 13

Adenosine - 0.1 mg/kg RVIP (max 6 mg); q @ 0.2 mg/kg (max 12 mg)

Question 14

Pediatric Tachycardic Algorithm (with pulses)

• Tachycardic with a pulse, persistent, unstable
  
  • Drug Therapy

Narrow Complex - Tachycardic with cardiopulmonary compromise
Wide Complex - Tachycardic WITHOUT cardiopulmonary compromise

Answer 14

Adenosine - 0.1 mg/kg RVIP (max 6 mg); q @ 0.2 mg/kg (max 12 mg)

Question 15

Pediatric Fluid Maintenance

• Infants
  
  • < 10 kg

Answer 15

4 mL/kg per hour

Question 16

Pediatric Fluid Maintenance

• Child
  
  • 10-20 kg

Answer 16

• 40 mL/kg per hour
• • 2 mL/kg/hr for each kilogram above 10 kg

Question 17

Pediatric Fluid Maintenance

• Child
  
  • > 20 kg

Answer 17

• 60 mL/kg per hour
• • 1 mL/kg/hr for each kilogram above 20 kg

Question 18

Pediatric Post-ROSC

• First Considerations

Answer 18

• FiO₂ - 94% +
• Adv Airway & Capnography
  
  • PCO2 - 35-45 mm Hg

Question 19

Pediatric Post-ROSC

• Assess & Treat Persistent Shock Steps

Answer 19

• H’s & T’s
• Consider Fluid Bolus
  
  • Consider inotropic or vasopressor support for fluid refractory shock