Paediatric (Non-traumatic)

Question 1

What are the clinical features of a non-traumatic paediatric cardiac arrest.

Answer 1

1. No signs of life:
   - Unresponsive
   - Inadequate respirations
   - Carotid pulse cannot be confidently palpated within 10 sec
2. Signs of inadequate perfusion:
   - Unresponsive
   - Pallor or central cyanosis
   - Pulse less than: 60 BPM in an infant (less than 1 year) 40 BPM in a paediatric (1-12 years)

Question 2

What are the priorities of paediatric resuscitation?

Answer 2

1. Airway patency
2. Adequate oxygenation
3. Two-person operated (where possible) BVM
4. High quality continuous CPR
5. Correction of reversible causes
6. Minimisation of on-scene times

Question 3

List some important considerations in paediatric resuscitation.

Answer 3

• The palpation of a perfusing pulse is difficult in paediatrics, therefore the determination of adequate circulation should also include other parameters such as ETCO2, pulse oximetry, cardiac monitoring & prehospital ultrasound
• In patients presenting in OHCA due to suspected SUDI ambulance clinicians should determine the following:
• The position of the paediatric when found
• The presence of bedding material obstructing the airway
• Evidence of shared sleeping
• Location of any blanching or lividity throughout the body (if present)
• Ambulance clinicians should consider placing a towel or blanket behind the shoulder blades of young patients (<8 years) when performing airway management to correct neck flexion
• BVM is superior to advanced airway adjuncts in paediatrics
• Advanced airway adjuncts may be considered in instances where resus may occur during transport or prolonged resus is anticipated
• Following the insertion of an advanced airway, ventilations should be performed as follows:
  <1 year - 25 (1 breath every 2.4 sec)
  >1 year - 20 (1 breath every 3 sec)
  >6 years - 15 (1 breath every 4 sec)

Question 4

Outline the protocol for non-traumatic paediatric resuscitation.

Answer 4

Suggested medical aetiology OHCA

Is there a potential airway obstruction?
If yes, manage as per FBAO CPG

If no,
- Commence continuous chest compressions (single officer 30:2, two officers 15:2) & apply defib pads

• Initiate rhythm analysis (1st analysis in AED mode for patients over 1 year)

Shockable rhythm (VF/pulseless VT)

1. Deliver single DCCS
   - <6 yrs (25kg) - 4J/kg (paediatric pads)
   - >6 yrs - 200J (adult pads)
2. Resume chest compression for 2 minutes
3. If refractory to 3 DCCS, consider:
   - IV/IO access
   - Amiodarone (CCP)
   - Adrenaline IV (Newly born 50 microg, <1 yr 100 microg, >1 yr 10 microg/kg)
   - Special circumstances

Non-shockable rhythm (PEA/asystole):

1. Resume chest compressions for 2 min
2. Consider:
   - Access
   - Adrenaline IV
   - Reversible causes
3. If refractory to standard resus measures, consider:
   - Contact the QAS consult line
   - Special circumstances

Manage as per ROSC or ROLE

Question 5

What are the ventilation rates for a paediatric in cardiac arrest?

Answer 5

<1 year - 25 (one breath every 2.4 sec)
1-6 years - 20 (one breath every 3 sec)
6-12 years - 15 (one breath every 4 sec)