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| ==Recommendations== | | ''See [[critical care quick reference]] for drug doses and equipment size by weight.'' {{Peds top}} [[ACLS (Main)]].'' |
| *Treat shock w/ initial 20cc/kg bolus | | ==Algorithms== |
| **Repeat boluses up to total of 60 mL/kg; thereafter pressors should be started
| | *[[BLS]] |
| *Do not routinely hyperventilate even in cases of head injury | | *[[Pediatric Pulseless Arrest]] |
| *Provide family w/ option of being present during resuscitation | | *[[PALS: Bradycardia]] |
| *IO is useful as initial vascular access
| | **Use [[Pediatric Pulseless Arrest]] algorithm if no pulse = PEA |
| *Self-Adhering Electrodes
| | *[[PALS: Tachycardia]] |
| **Use largest size that will fit on child’s chest w/o touching | |
| **When possible leave 3cm between electrodes
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| **Adult size for >10kg; infant size for <10kg | |
| *Hypotension is defined as sys BP:
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| **<60 (0 to 28 days)
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| **<70 (1mo - 12mo)
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| **<70 + (2 X age in yr) (1-10yr)
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| **<90 (≥10yr)
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| ==BLS== | | ==See Also== |
| *Compressions | | *[[AHA Recommendation Changes by Year]] |
| **Push hard (≥ 1/3 chest diameter) and fast (≥100/min) | | *[[Synchronized cardioversion]] |
| *Ventilations
| | *[[Post Cardiac Arrest]] |
| **NO perfusing rhythm | | *[[ACLS (Main)]] |
| ***15:2 ratio when do not have advanced airway | | *[[ACLS (Treatable Conditions)]] |
| ****Do not overventilate! (leads to decr venous return)
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| ****Deliver breath with inspiratory time of 1s | |
| ***8-10 breaths per min when intubated
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| **YES perfusing rhythm
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| ***Give rescue breaths 12-20 per min (“squeeze-release-release”)
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| ==Advanced Airway==
| | {{Pediatric critical care pages}} |
| *Cuffed and uncuffed ETT are acceptable
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| **Uncuffed
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| ***<1yo - 3.5mm ETT
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| ***1-2yo - 4mm ETT
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| ***>2yo - 4 + (age/4)
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| **Cuffed
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| ***<1yo - 3mm ETT
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| ***1-2yo - 3.5mm ETT
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| ***>2yo - 3.5 + (age/4)
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| ==Pulseless Arrest== | | ==External Links== |
| ===Asystole and PEA===
| | *[https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf 2020 AHA Guidelines] |
| *Give Epi 0.01 mg/kg (0.1 mL/kg 1:10,000) (max 1mg) q3-5min | |
| *Rhythm check q2min
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| *Consider H's and T's
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| **Hypovolemia
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| **Hypoxia
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| **Hydrogen ion
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| **Hypo/hyperkalemia
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| **Hypothermia
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| **Tension pneumo
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| **Tamponade
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| **Toxins
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| **Thrombosis, pulmonary
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| **Thrombosis, coronary
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| ===VF/Pulseless VT=== | | ==References== |
| *Shock as quickly as possible and resume CPR immediately
| | <references/> |
| **First shock 2 J/kg
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| **Second shock 4 J/kg
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| **Subsequent shocks ≥ 4 J/kg (max 10 J/kg)
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| *Give Epi if (shock + 2min CPR) fails to convert rhythm
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| *Perform pulse check/shock if appropriate q2min
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| *Give antiarrhythmic if (2nd shock +2min CPR) again fails
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| **1st line: Amiodarone
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| ***5 mg/kg (max 300mg)
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| ***May repeat twice up to 15mg/kg
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| **2nd line: Lidocaine
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| ***1 mg/kg
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| **Magnesium
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| ***25-50mg/kg (max 2g) IV
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| ***Only for polymorphic V-tach
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| ==Bradycardia==
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| *Algorithm assumes pulse and poor perfusion (low BP, AMS, shock)
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| **Start CPR if HR <60/min w/ poor perfusion
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| ***Recheck after 2min; if poor perfusion persists:
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| ****Give Epi 0.01 mg/kg (0.1 mL/kg 1:10,000)
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| ****Give Atropine 0.02mg/kg
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| *****Only if due to incr vagal tone or AV block (not hypoxia)
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| ****Transcutaneous pacing
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| *****Consider if bradycardia is due to complete heart block
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| ==Tachycardia==
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| *Algorithm assumes pulse and adequate perfusion
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| ===Narrow-Complex===
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| *Sinus tachycardia - treat underlying cause
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| *Supraventricular
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| **Vagal stimulation (if will not delay meds/cardioversion)
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| ***Infants/young children: apply ice to face
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| ***Older children: Carotid sinus massage / Valsalva
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| **Synchronized cardioversion
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| ***Use if unstable or adenosine ineffective
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| ***Give 0.5-1 J/kg; if unsuccessful increase to 2 J/kg
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| ****Give 2nd shock consider amiodarone OR procainamide before 3rd shock
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| *****Amiodarone 5 mg/kg over 20-60min
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| *****Procainamide 15 mg/kg over 30-60min
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| **Adenosine
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| **0.1 mg/kg; immediately flush w/ 5cc NS
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| ===Wide-Complex===
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| *Adenosine for differentiating SVT from VT
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| **Consider only if rhythm is regular and QRS monomorphic
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| *Synchronized cardioversion
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| **Give 0.5-1 J/kg; if unsuccessful increase to 2 J/kg
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| **Give 2nd shock consider amiodarone OR procainamide before 3rd shock
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| ***Amiodarone 5 mg/kg over 20-60min
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| ***Procainamide 15 mg/kg over 30-60min
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| ==Source==
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| AHA 2010 Guidelines for PALS | | AHA 2010 Guidelines for PALS |
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| [[Category:Peds]] | | [[Category:Critical Care]] |
| | [[Category:Cardiology]] |
| | [[Category:Pediatrics]] |
| | [[Category:EMS]] |
