Pediatric Emergencies and Resuscitation, part 2 (Nelson) Flashcards
The most important treatment of cardiac arrest is
Anticipation and prevention
Intervening when a child manifests respiratory distress or early stages of shock can prevent deterioration to full arrest
An unwitnessed pediatric cardiac arrest in an outpatient setting should be treated as
asphyxial in nature
Immediately initiate CPR, and activate EMS
A witnessed pediatric cardiac arrest in an outpatient setting should be treated as
primary arrhythmia
Immediately activate EMS, and obtain AED
Initiate defibrillation at what joules?
2 J/kg
PEA is also called
electromechanical dissociation
For persistent PEA, you should
search and manage reversible causes (Hs and Ts)
Corrective actions for acidosis
Reassess the adequacy of cardiopulmonary resuscitation, oxygenation, and ventilation; reconfirm ETT placement
Hyperventilate
Consider IV bicarbonate if pH <7.2 after above actions have been taken
First action for a cardiac tamponade
Adminster fluids first
Then pericardiocentesis
Severe hypothermia is
<30 C - limit shocks for Vfib or pulseless Vtach to 3; initiate active internal rewarming and cardiopulmonary support
Moderate hypothermia is
30-34 C
Proceed with resuscitation (space medications at longer intervals)
passively rewarm child
and actively rewarm truncal body areas
Thoracotomy is appropriate when?
When a patient has cardiac arrest from penetrating trauma and a cardiac rhythm is present and the duration of CPR before thoracotomy is <10 mins
How to manage cardiac arrest from hypomagnesemia
1-2 g magnesium sulfate IV over 2 mins
How to manage cardiac arrest from hypokalemia
If profound hypokalemia (<2.0 - 2.5 mmol of potassium) is accompanied by cardiac arrest, initiate urgent IV replacment (2 mmol/min IV for 10-15 mmol)
Most notable scalp veins are
superficial temporal vein (just anterior to ear)
and posterior auricular vein (just behind the ear)
Remarks on IO access
If venous access is not available within approximately 1 min in a child with cardiopulmonary arrest, an IO needle should be placed in the anterior proximal tibia
Medications that can be given through the ETT
Epinephrine (10x normal IV dose)
Atropine
Naloxone
Vasopressin
(the rest are dosed 2x normal IV dose)
Pulse pressure in cardiac tamponade
Narrow pulse pressure
(in the presence of increased CVP is cardiac tamponade until proven otherwise)
Remarks on induced hypothermia
Induced hypothermia has NOT been shown to improve survival and neurologic function in pediatric survivors of CPR
Remarks on resuscitation communication with patient’s family
- Should be done by the most senior provider available.
- For situations in which the resuscitation is ongoing and the child is not expected to survive, it is recommended that the provider make every effort possible to have the family present at the bedside, if they wish.
- Family presence during CPR or other emergency resuscitative efforts, even if the child dies, is associated with a more positive medical experience than if they are excluded
Dose of amiodarone
5 mg/kg IV/IO
repeat up to 15 mg/kg
Max 300 mg
Dose of atropine
0.02 mg/kg IV/IO
0.03 mg/kg ETT
Minimum dose: 0.1 mg
Minimum single dose:
Child, 0.5 mg
Adolescent, 1 mg
Epinephrine dosing
IV/IO
0.01 mg/kg (0.1 mL/kg 1:10,000)
max 1 mg
ETT
0.1 mg/kg (0.1 mL/kg 1:1,000)
max 10 mg
Glucose dosing for hypoglycemia
0.5-1 g/kg IV/IO
D10W: 5-10 mL/kg
D25W: 2-4 mL/kg
D50W: 1-2 mL/kg
Magnesium sulfate dosing for arrhythmia
25-50 mg/kg IV/IO over 10-20 mins
faster in torsades de pointes
max dose 2g
