Pediatric Cardiopulmonary Resuscitation Flashcards
Bradycardia Algorithm
Bradycardia persists after CPR
Epinephrine
Atropine: For increased vagal tone or primary AV block
Consider thransthoracic pacing/transvenous pacing
Treat underlying cause
Bradycardia Algorithm
Epinephrine Dose
Give epinephrine if bradycardia persist despite effective CPR
0.01 mg/kg or 0.01mg/mL
Repeat every 3-5 min
Cardioversion
Indications
Unstable SVT
atrial Flutter
VT with a pulse
Cardioversion
Energy Dose
Start with 0.5-1 J/kJ for cardioversion then increase to 2J/kg
Adenosine Dose
0.1mg/kg (max 6 mg/kg) as a rapid IV bolus
Second dose is 0.2 mg/kg (max 12 mg)
Amiodarone Dose
Loading dose of 5 mg/kg (max 300mg)
Repeat dose of 5 mg/kg to a max 15 mg/kg as needed
Procainamide Dose
IV/IO
15 mg/kg
IBW <1 Year Old
(Age +9) / 2
IBW 1-6 years
(Age x2) + 8
IBW 7-11 Age
([Year x 7] -5) /2
Cardiac Arrest Alorigthm First Steps
1) Inital Impression (ABC)
2) Does the child need immediate intervention and if so call for help
Cardiac Arrest Alorigthm First Steps
Breathing and Pulse Assessment
No Breathing OR No pulse and gasping: Start CPR
No Breathing but pulse is present: Begin Ventilation
Breathing and Has a Pulse: Check for severe compromise in airway, circulation or perfusion and then move on to evaulation
Tube Depth
ETT Size x 3
OR
(Age/2) + 12
ETT Drugs How to administer
Give 5 Manual Ventilations
This is one of the only things we will stop comrpessions for
Cardiac Arrest Alorigthm
What rhythms are shockable
VF
Pulseless VT
Cardiac Arrest Alorigthm
What do you do after the shock
After the 1st shock: Get access, do CPR for 2 min and then reassess
After the 2nd shock: Give Epinephrine, then CPR for 2 min then reassess
After the 3rd shock: Give aminodarone or lidocaine, think of reversible causes, then CPR for 2 min then reassess and start over
Cardiac Arrest Alorigthm
What Rhythms are Not Shockable and what do we do if we can not shock
Asytole and PEA are not shockable
We can give epinephrine every 3-5 min and consider a advanced airway
Defibrillation Amounts
2 J / kg ►4J /kg ► not exeed 10 J/kg
Bradycardia with a Pulse Algorithm
First Steps
1) Treat Underlying Cause
2) Check if there is Cardiopulmonary compromise and if CPR needs to be started.
Lidocaine Dose
Initial: 1 mg/kg
Maintance: 20-50 mcg/kg
Bradycardia with a Pulse Algorithm
If Bradycardia persist even with effective CPR
Consider epinephrine
Consider Atropine for increased vagal tone (primary AV block)
Consider trancutaneous pacing
Atropine Dose
0.02 mg/kg
May repeat once
Minimum dose 0.1 mg and Max dose is 0.5 mg
Tachycardia With a Pulse and Poor Perfusion
First Steps
1) Identify and Treat Underlying Cause
2) Evulate QRS Duration (Narrow is <0.09 and Wide is >0.09)
Tachycardia With a Pulse and Poor Perfusion
Narrow (<0.09) what rhythm would it be
It could be Sinus Tachycardia or it could be Supraventricular Tachycardia
Tachycardia With a Pulse and Poor Perfusion
Supraventricular Tachycardia
Compatible history that is vague and nonpsecific
P waves are absent/abnormal
Infants >220
Children >180
Tachycardia With a Pulse and Poor Perfusion
Sinus Tachycardia
Compatible history with a known cause
P waves are present and normal
R-R is consistent
Infants <220
Children <180
Tachycardia With a Pulse and Poor Perfusion
Supraventricular Tachycardia
Treatment
Consider Vagal Manoevuers
Adenosine
If adenosine is not working then consider cardioversion
Tachycardia With a Pulse and Poor Perfusion
Sinus Tachycardia
Treatment
Search and treat causes
Tachycardia With a Pulse and Poor Perfusion
Wide QRS Duration What rhythm could it be
Ventricular Tachycardia
Tachycardia With a Pulse and Poor Perfusion
Ventricular Tachycardia What Should We Assess First
Cardiopulmonary Compromise
Tachycardia With a Pulse and Poor Perfusion
Ventricular Tachycardia Treatment when there is cardiopulmonary Compromise
Synchronized Cardioversion
Tachycardia With a Pulse and Poor Perfusion
Ventricular Tachycardia Treatment when there is not cardiopulmonary Compromise
Consider adenosine if rhythm is regular and QRS is monomorphic
Expert consultation and can consider aminodarone and procainamide
