PALS - Cardiac Arrest and ROSC Flashcards
Describe the initial approach to a pulseless patient.
Call code pink / code blue
Don PPE
Start CPR straight away
Apply monitor-defibrillator and perform a rhythm check as soon as possible
Is this rhythm shockable or non-shockable?
What are the components of high quality CPR? Name 5.
1) Adequate rate
100-120 bpm
Use a metronome to ensure adequate rate
2) Adequate depth 1/3 AP chest diameter 4cm infants 5cm children Use a stool and a backboard to help achieve adequate depth
3) Adequate (full) chest recoil
4) Minimize interruptions
No time off chest >10s
5) Minimize over-ventilation
6) Rotate compressors every 2 minutes regardless of perceived fatigue
Energy provider is designated as the CPR coach
7) Monitor CPR quality
Target an end-tidal CO2 > 10
What is adequate depth of chest compressions in pediatric CPR?
1/3 AP chest diameter
4cm infants
5cm children
Use a stool and a backboard to help achieve adequate depth
What is the correct compression to ventilation ratio without an advanced airway?
Puberty or older
30:2 (as in adults)
Single rescuer
30:2
Dual rescuer
15:2 (more frequent ventilations in children due to respiratory etiology of arrest)
What is the correct ventilation rate in children once an advanced airway has been placed?
New for 2020:
One breath every 2-3 seconds
This produces a respiratory rate of 20 breaths per minute
Compare one breath every 6 seconds or 10 breaths per minute in adults
What are the shockable rhythms in cardiac arrest?
Ventricular fibrillation
Pulseless ventricular tachycardia
Describe the treatment of shockable cardiac arrest in PALS.
Initial assessment and rhythm check shows VF/VT:
1) First shock at 2J/kg
Shock as soon as shockable rhythm is diagnosed
Continue CPR for two minutes and perform a rhythm check / pulse check and shock again if indicated
Establish an advanced airway, preferably a cuffed endotracheal tube, as soon as possible in the context of covid-19
2) Second Shock 4J/kg
Give epinephrine after the second shock and again every 3-5 minutes
Continue CPR x two minutes
3) Third Shock 6J/kg
Give amiodarone after the third shock
Consider potential reversible causes (Hs and Ts)
What is the initial defibrillation dose of energy in pediatric cardiac arrest?
2 J/kg
Increase by 2 J/kg to a maximum of 10 J/kg
“2-4-6-8 this is how we defibrillate”
What is the IV dose of epinephrine in pediatric cardiac arrest?
0.01 mg/kg of 1:10,000 (dilute epi, cardiac epi, IV epi)
Repeat every 3-5 minutes
What is the IV dose of amiodarone in pulseless VT/VF?
5mg/kg
May repeat up to 3 total doses
What are the non-shockable rhythms in cardiac arrest?
PEA
Asystole
Describe a slightly nuanced approach to PEA.
Distinguish true PEA from pseudo-PEA
During pulse checks, apply an the vascular probe to the carotid artery and look for pulsations versus collapsibility
Do not interrupt chest compressions for >10s
Describe the treatment of pseudo-PEA.
Basically it’s a profound shock state
Start high-dose vasopressors and begin the search for the underlying cause
Avoid cardiac arrest doses of epinephrine as these may be harmful
Describe the treatment of true PEA and asystole as per PALS.
Provide ongoing CPR with rhythm/pulse checks every 2 minutes
Rapidly establish an advanced airway, preferably a cuffed endotracheal tube in the context of Covid-19
Administer epinephrine as soon as PEA/asystole is diagnosed and repeat every 3-5 minutes
Identify and treat the underlying cause of cardiac arrest.
Describe an evaluation that can be performed during cardiac arrest to help identify a reversible underlying cause.
History - SAMPLE
Physical exam - auscultate lungs and look for signs of DVT
Labs - Finger-stick glucose, blood gas for electrolytes
Imaging - Bedside ultrasound for pericardial effusion
