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| ==Recommendations==
| | ''See [[critical care quick reference]] for drug doses and equipment size by weight.'' {{Peds top}} [[ACLS (Main)]].'' |
| IO access is a rapid, safe, effective, and acceptable route for
| | ==Algorithms== |
| vascular access in children,172–179,181 and it is useful as the
| | *[[BLS]] |
| initial vascular access in cases of cardiac arrest
| | *[[Pediatric Pulseless Arrest]] |
| | | *[[PALS: Bradycardia]] |
| *Use the largest paddles or self-adhering electrodes265–267 that
| | **Use [[Pediatric Pulseless Arrest]] algorithm if no pulse = PEA |
| will fit on the child’s chest without touching (when possible,
| | *[[PALS: Tachycardia]] |
| leave about 3 cm between the paddles or electrodes
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| Adult” size (8 to 10 cm) for children �10 kg
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| (� approximately 1 year)
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| ● “Infant” size for infants �10 kg
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| *hypotension is defined as a systolic blood pressure:
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| 60 mm Hg in term neonates (0 to 28 days)
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| 70 mm Hg in infants (1 month to 12 months)
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| 70 mm Hg � (2 � age in years) in children 1 to 10 years
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| 90 mm Hg in children �10 years of age
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| ==BLS== | |
| *Compressions | |
| **Push hard (≥ 1/3 chest diameter) and fast (≥100/min)
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| *Ventilations
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| **NO perfusing rhythm
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| ***15:2 ratio when do not have advanced airway
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| ****Do not overventilate! (leads to decr venous return)
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| ****Deliver breath with inspiratory time of 1s
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| ***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==
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| *Cuffed and uncuffed ETT are acceptable
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| **Uncuffed
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| ***<1yo - 3.5mm ETT | |
| ***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==
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| ===Asystole and PEA===
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| *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 | |
| **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===
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| *Shock as quickly as possible and resume CPR immediately
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| **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== | |
| *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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| If pulses are palpable and the patient has adequate
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| perfusion:
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| Narrow-Complex (<0.09 Second) Tachycardia
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| Supraventricular Tachycardia
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| Attempt vagal stimulation (Box 7) first, unless the patient
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| is hemodynamically unstable or the procedure will unduly
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| delay chemical or electric cardioversion (Class IIa, LOE C).
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| In infants and young children, apply ice to the face without
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| occluding the airway
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| In older children, carotid sinus massage or Valsalva maneuvers
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| are safe.
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| Pharmacologic cardioversion with adenosine (Box 8) is
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| very effective with minimal and transient side effects.300–304 If
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| IV/IO access is readily available, adenosine is the drug of
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| choice (Class I, LOE C). Side effects are usually transient.
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| 300–304 Administer IV/IO adenosine 0.1 mg/kg using 2
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| syringes connected to a T-connector or stopcock; give
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| adenosine rapidly with 1 syringe and immediately flush
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| with �5 mL of normal saline with the other
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| If the patient is hemodynamically unstable or if adenosine
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| is ineffective, perform electric synchronized cardioversion
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| (Box 8). Use sedation, if possible. Start with a dose of 0.5
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| to 1 J/kg. If unsuccessful, increase the dose to 2 J/kg (Class
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| IIb, LOE C). If a second shock is unsuccessful or the
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| tachycardia recurs quickly, consider amiodarone or procainamide
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| before a third shock
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| Consider amiodarone 5 mg/kg IO/IV308,309 or procainamide
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| 15 mg/kg IO/IV236 for a patient with SVT unresponsive to
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| vagal maneuvers and adenosine and/or electric cardioversion;
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| for hemodynamically stable patients, expert consultation
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| is strongly recommended prior to administration
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| (Class IIb, LOE C). Both amiodarone and procainamide
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| must be infused slowly (amiodarone over 20 to 60 minutes
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| and procainamide over 30 to 60 minutes), depending on the
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| urgency, while the ECG and blood pressure are monitored.
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| If there is no effect and there are no signs of toxicity, give
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| additional doses (Table 1). Avoid the simultaneous use of
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| amiodarone and procainamide without expert consultation.
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| Wide-Complex (>0.09 Second) Tachycardia
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| Adenosine may be useful in differentiating SVT from VT
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| and converting wide-complex tachycardia of supraventricular
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| origin (Box 12). Adenosine should be considered only
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| if the rhythm is regular and the QRS is monomorphic
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| Consider electric cardioversion after sedation using a
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| starting energy dose of 0.5 to 1 J/kg. If that fails, increase
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| the dose to 2 J/kg
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| Consider pharmacologic conversion with either intravenous
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| amiodarone (5 mg/kg over 20 to 60 minutes) or
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| procainamide (15 mg/kg given over 30 to 60 minutes)
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| while monitoring ECG and blood pressure. Stop or slow
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| the infusion if there is a decline in blood pressure or the
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| QRS widens
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| Treat signs of shock with a bolus of 20 mL/kg of isotonic
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| crystalloid even if blood pressure is normal
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| Do not routinely hyperventilate even in case of head injury
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| Whenever possible, provide family
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| members with the option of being present during resuscitation of
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| an infant or child
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| | ==See Also== |
| | *[[AHA Recommendation Changes by Year]] |
| | *[[Synchronized cardioversion]] |
| | *[[Post Cardiac Arrest]] |
| | *[[ACLS (Main)]] |
| | *[[ACLS (Treatable Conditions)]] |
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| | {{Pediatric critical care pages}} |
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| | ==External Links== |
| | *[https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf 2020 AHA Guidelines] |
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| | ==References== |
| | <references/> |
| | AHA 2010 Guidelines for PALS |
|
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|
| | | [[Category:Critical Care]] |
| | | [[Category:Cardiology]] |
| | | [[Category:Pediatrics]] |
| | | [[Category:EMS]] |
| ==Diagnosis==
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| ==Work-Up==
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| ==DDx==
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| ==Treatment==
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| ==Disposition==
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| ==See Also==
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| ==Source==
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| [[Category:Peds]] | |
