Pulseless arrest (peds)

This page is for pediatric patients. For adult patients, see: pulseless arrest. See critical care quick reference for drug doses and equipment sizes by weight.

Asystole and PEA

• Give Epi 0.01mg/kg (0.1 mL/kg 1:10,000) (max 1mg) q3-5min
• Rhythm check q2min
• Prioritize adequate oxygenation and ventilation, as respiratory arrest is the most common cause of pediatric cardiac arrest
• Consider H's and T's
  • Hypoglycemia
  • Hypovolemia
  • Hypoxia (most common cause of pediatric arrest)
  • Hydrogen ion
  • Hypokalemia or hyperkalemia
  • Hypothermia
  • Tension pneumothorax
  • Tamponade
  • Toxins
  • Thrombosis, pulmonary
  • Thrombosis, coronary

Ventricular fibrillation/Pulseless Ventricular Tachycardia

• Shock as quickly as possible and resume CPR immediately
  • First shock 2 J/kg
  • Second shock 4 J/kg
  • Subsequent shocks ≥ 4 J/kg (max 10 J/kg)
• Give Epi if (shock + 2min CPR) fails to convert rhythm
• Perform pulse check/shock if appropriate q2min
• Give antiarrhythmic if (2nd shock + 2min CPR) again fails
  • 1st line: Amiodarone
    • 5mg/kg (max 300mg)
    • May repeat twice up to 15mg/kg
  • 2nd line: Lidocaine
    • 1mg/kg
  • Magnesium
    • 25-50mg/kg (max 2g) IV
    • Only for polymorphic V-tach

See Also

• PALS (Main)
• Adult Pulseless Arrest
• Post Cardiac Arrest
• Brain Death
• Critical care quick reference

References

AHA 2010 Guidelines for PALS