Pediatric Cardiac

Question 1

Unstable Bradycardia

Answer 1

Scene safe > BSI > ABC’s > Vitals

• Assess for hemodynamic instability
• If not unstable, no therapy is needed

1) O2, Monitor, IV/IO (12 lead if it doesn’t delay care)
2) Start CPR with a rate below 60 with poor perfusion
3) Epi .01 mg/kg every 3-5 min OR
Atropine .02 mg/kg every 3-5 min OR
Pace @ 80 bpm if needed
4) Transport

Question 2

Stable SVT

Answer 2

Scene safe > BSI > ABC’s > Vitals

1) O2, Monitor, IV
2)CMC
3) Vagal w/ ice or cold wet rag on face
4) Adenosine .1 mg/kg then .2 mg/kg (1st max 6, 2nd max 12) OR
Synchronized cardioversion if needed .5-1 J/kg , 2 J/kg
5) Amiodarone 5 mg/kg/30-60 min OR
Procainamide 15 mg/kg/30-60 min

Question 3

Unstable SVT

Answer 3

Scene safe > BSI > ABC’s > Vitals
- Above 180 for children and 220 for infants

1) O2, Monitor, IV
2) Adenosine .1 mg/kg then repeat at .2 mg/kg (1st max 6, 2nd max 12)
OR
Synchronized cardioversion .5-1 J/kg , 2 J/kg
3) CMC

Question 4

Stable VTach

Answer 4

Scene safe > BSI > ABC’s > Vitals
-Above 180 children, 220 infants

1) O2, Monitor, IV/IO
2) CMC
3) Adenosine .1 mg/kg , then .2 mg/kg (diagnostic)
4) Amio 5 mg/kg/30-60 min
OR
Procainamide 15 mg/kg/30-60min
OR
Cardioversion .5-1 J/kg, then 2 J/kg

Question 5

Unstable VTach

Answer 5

Scene safe > BSI > ABC’s > Vitals
-Above 180 for children, 220 for infants

1) O2, Monitor, IV/IO
2) Synchronized cardioversion .5-1 J/kg , then 2 J/kg
3) CMC
4) Amio 5 mg/kg/20-60 min
OR
Praocainamide 15 mg/kg/30-60 min

Question 6

Pulseless Vfib/VTach

Answer 6

Scene safe > BSI > ABC’s

1) CPR, O2, Monitor, IV/IO, Defib 2 J/kg
2) CPR, Epi, Intubate w/ capno, Defib 4 J/kg
3) CPR
Amio 5 mg/kg/every 3-5 min (max single dose of 15 mg)
Lidocaine 1 mg/kg (max of 100 mg)
Mag25-50 mg/kg/10-20 min
Causes, Defib
4) CPR, Epi, Continue antidysrhythmic, Defib
5) Consider termination

Question 7

Asystole/PEA

Answer 7

Scene safe > BSI > ABC’s

1) CPR, O2, Monitor, Determine rhythm, IV/IO, Epi
2) CPR, Epi, Intubate w/ capno, Check rhythm
3) CPR, Epi, Reversible causes, Check rhythm
4) CPR, Epi, check rhythm
5) Consider termination

Question 8

ROSC

Answer 8

1) Reassess
2) O2 (94-99%), Monitor, NG/OG, Pain management
3) 12-lead, Ensure adequate BP with fluids, Dopamine,
Dobutamine, Epi
4) Neurological support, Maintain temp
5) Treat shock if needed