A case based update: 2010 pediatric basic and advanced life-support guidelines

Question 1

What is the new priority regarding asystolic cardiac arrest?

Answer 1

Compressions first

Question 2

What is an optimal chest compression?

Answer 2

1. Depth: 1/3 anterior-posterior diameter of the chest or 4cm in infants and 5cm in children
2. Allow full recoil
3. Minimize interruptions
4. Avoid excessive ventilation
5. Rotate the compressor role q2min
6. No more than a 5s pause for compressor switches
7. Limit pulse checks to max 10s

Question 3

Is hands only CPR appropriate for infants and children?

Answer 3

NO!! Pediatric cardiac arrest is primarily asphyxial

Question 4

How should a rescuer decide whether CPR is necessary?

Answer 4

1. Lay rescuer: assess for responsiveness and breathing

2. HCP: may do pulse check but max 10s

Question 5

Can AED be used in infants in cardiac arrest?

Answer 5

Yes
Recommended method is manual defibrillation, then AED w/ pediatric dose attenuator (up to 25kg or 8yo), then standard adult AED

Question 6

What is the optimal shock dose for defibrillation?

Answer 6

Initial shock dose 2-4 J/kg

Subsequent dose 4-10 J/kg

Question 7

What are appropriate post-arrest care considerations?

Answer 7

1. Maintain O2 94-99%

2. Consider therapeutic hypothermia 32-34 degrees if child is comatose

Question 8

What is the appropriate next step in management of wide complex tachycardia?

Answer 8

Adenosine to determine if SVT or ventricular (new definition QRS > 0.09s)
Only if regular monomorphic QRS
Avoid if known WPW

Question 9

How should medication doses be calculated in obese children?

Answer 9

Actual patient weight up to adult maximum

Use length-based tapes if weight not known

Question 10

What fluid is best for septic shock?

Answer 10

Crystalloid rapid bolus 20mL/kg as initial choice

Question 11

Should etomidate be used as the sedative during RSI of a child in septic shock?

Answer 11

No as its associated with adrenal suppression and higher mortality rates

Question 12

What is the optimal endotracheal tube size?

Answer 12

Cuffed tubes:
- 3.0mm <1yo
- 3.5mm 1-2yo
- >2yo: 3.5 + (age/4)
Uncuffed tube:
- 0.5mm larger than cuffed tube

Question 13

Is cricoid pressure recommended during intubation?

Answer 13

There is insufficient evidence as it may interfere with the speed or ease of intubation

Question 14

What else is new in the 2010 guidelines?

Answer 14

Management recommendations for infants and children w/ CHD (single ventricle physiology and pulmonary hypertension)
Guidelines on how to explore cause of sudden, unexpected death