PALS: CARDIAC ARREST Flashcards
Approach to Cardiopulmonary Arrest
INITIAL IMPRESSION:
Check Level of Consciousness, breathing, circulation
IF UNREPONSIVE:
shout for help
check breathing / pulse:
No breathing
OR
Only gasping
AND
No pulse
START CPR
100-120 compressions / min
Monitor
Oxygen
Vitals
IV / IO
ECG / Airway Equipment
Use Breslow tape if between 1-40 kg
AIRWAY / BREATHING:
Bag Valve Mask
Consider supraglottic device
Capnography > 20 mmHg reassuring
Pulse Oximetry
CIRCULATION:
IV access, IO within 2 min
Monitor
Continue CPR
V-Vib / Pulseless V Tach:
Defibrillate 2 J / kg
epinephrine (0.01 mg/kg = 0.1 mL/kg of 1:10,000 dilution)
Defibrillate 4 J / kg
epinephrine (0.01 mg/kg = 0.1 mL/kg of 1:10,000 dilution)
Defibrillate 4-10 J / kg
Amiodarone 5 mg / kg over 30 min
PEA / Asystole:
epinephrine (0.01 mg/kg = 0.1 mL/kg of 1:10,000 dilution) q 3-5 min
DISABILITY
POC Glucose
Most common recognizable signs of cardiac arrest
Unresponsiveness
No breathing or only gasping
No pulse
Criteria to initiate CPR
All three of:
Unresponsiveness
No breathing or only gasping
No pulse
First Step of Pulseless Arrest
Shout for Help
Activate Emergency Response
Second step of Pulseless arrest
Start CPR
Give Oxygen
Attach Monitor / Defibrillator
6 key characteristics of Quality CPR
Push hard: >/ 1/3 the anteroposterior diameter of the chest with complete recoil
Push fast: 100-120 compressions/min
Minimize interruptions in chest compressions
Rotate compressors every 2 minutes or sooner
Avoid excessive ventilation
If NO advanced airway, 15:2 compression-ventilation ratio
Ventilation rate if NO advanced airway (2 rescue vs. 1 rescue CPR)
2 rescue: 15:2
1 rescue: 30:2
Ventilation rate for advanced airway
1 breath every 6 seconds
Ventilation Cadence
Infant = squeeze, release
Young Child = squeeze, release, release
Older Child = squeeze, release, release, release
Formula to estimate ET size for children 2-10 years old: Cuffed vs. Uncuffed
Cuffed:
(age / years/4) + 3.5
Uncuffed:
(age / years/4) + 4
Standard pediatric dosing for defibrillation
First shock: 2 J/kg
2nd shick: 4 J/kg
Subsequent shocks:
4 J/kg - 10 J/kg
Max 10 J / kg or 360 J
Cardiac Arrest Epinephrine Dose, Concentration & frequency
0.01 mg/kg = 0.1 mL/kg of 1:10,000 dilution) IV/IO
0.1 mg/mL conc
Administer q 3-5 min
Cardiac Arrest Amiodarone Dosing
5mg/kg IV / IO over 30 min
May repeat X 2 for refractory VF/pulseless VT
Lidocaine dose, maintenance infusion
Initial bolus dose: 1 mg/kg IV / IO
Maintenance infusion: 20-50 mcg/kg/min
Magnesium Indications, Dosing, max Dose
torsades de pointes
25-50 mg/kg
Max: 2 g
List the reversible causes of cardiac arrest (H’s & T’s)
Hypovolemia
Hypoxia
Hypoglycemia
Hydrogen Ion (Acidosis)
Hypothermia
Hypo / Hyperkalemia
Tension Pneumo
Tamponade
Toxins
Thrombosis: massive MI
Thrombosis: massive PE
Hypovolemia Intervention
Expose patient and look for signs of blood loss
Obtain IV access
Use fluid challenge to determine if arrest is related to hypovolemia
20 ml / kg bolus
10 ml / kg blood
Hypoxia Intervention
Ensure that the airway
is open.
Ensure adequate
ventilation and bilateral
breath sounds.
Ensure oxygen supply is
connected properly.
Hydrogen Ion (acidosis) intervention
VBG
Provide Adequate Ventilations
1 mEq / kg IV sodium bicarbonate to prevent metabolic acidosis if necessary
Hypoglycemia intervention
obtain a POC blood glucose (BG) level.
A BG ≤ 3.3 mmol/l in a child and ≤ 2.5 mg/dl in an infant
5 cc / kg D10 W - neonate
2 cc / kg D25 W - infant
1 cc / kg D50 W - child
Glucagon 0.03 mg / kg IM / SC (max 0.5 mg)
Hyper / Hypokalemia intervention:
Calcium Gluconate
Clacium Chloride
Obtain ECG
Give diluted potassium
OR
Calcium gluconate:
60 mg / kg (0.6 ml/kg)
Calcium chloride:
20 mg / kg (0.2 ml/kg)
Calcium Gluconate dosing
1 amp = 1 g
Hypothermia intervention
Core temp. should be
raised above (30 C)
as soon as possible.
The patient may not
respond to drug or
electrical therapy while
hypothermic.
Tension Pneumothorax ECG signs, Physical Signs, intervention
ECG signs: Narrow QRS complexes and slow or fast heart rate.
Physical signs: JVD, tracheal deviation, unequal breath
sounds, difficulty with ventilation, and no pulse felt
with CPR.
Treatment: Needle decompression.
