PALS: POST-CARDIAC ARREST

Question 1

Goals of Resuscitation: Pa02
PaC02
Glucose
MAP
Temp

Answer 1

Sp02: 94-99%
Pa02: > 80 mm Hg
PaC02: 35-45 mm Hg
Glucose: 80-180 mg / dL
MAP: SBP > 50th percentile = 90 + age x 2
Temp: 36 - 37.5 C

Question 2

Evaluate: How to estimate adequate blood pressure?

Answer 2

SBP > 50th percentile = 90 + age x 2

Question 3

Ventilator Settings:
> 10 Kg

Answer 3

Volume Cycle Ventilator

Tital Volume 6-9 ml / kg

Rate: Pre-intubation rate

Fi02 100% - rapid titrate

Rapid PEEP: 2-5 cm H20

Inspiratory time: 0.5-1 seconds

1:2 or 1:3

Question 4

Ventilation Settings:
<10 kg

Answer 4

Pressure Cycle Ventilator

Peak Inspiratory Pressure 20-25 mmHg

Assist Control (AC)

SIMV

Question 5

Intervention: How to determine fluid resuscitation

Answer 5

10-20 ml/kg boluses of isotonic crystalloid over 5-20 min.

reassess after each bolus

small volume boluses of 5-10 ml/kg in suspected heart failure

Question 6

Inotropes for Hypotensive Shock

Answer 6

Epinephrine:

Vasoactive med of choice for Infants and Children with fluid refractory hypotensive shock

4 mg epinephrine is mixed with 250 ml of NS

0.01-0.5 mcg/kg/min

Usual 0-0.3 mcg/kg/min

Norepinephrine:
4 mg OR 8 mg in 250 ml saline = 16 ug / ml or 32 ug / ml

0.05 - 0.5 mcg / kg / min

Question 7

Normotensive:

Answer 7

Epinephrine:
4 mg epinephrine is mixed with 250 ml of NS

0.01-0.5 mcg/kg/min
Usual 0-0.3 mcg/kg/min

Dobutamine:
250 mg in 250 mL NS or D5W
(1000 mcg/mL)

2 - 20 mcg / kg / min

Milrinone
50 mcg / kg over 30 min
THEN
0.25-0/75 mcg / kg / min

Question 8

Norepinephrine: Indications, Dosing

Answer 8

fluid refractory hypotensive shock with low systemic vascular resistance

0.03-0.5 mcg/kg/min