Download Pediatric Pulseless Arrest

Pediatric Pulseless Arrest
History
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Differential
Signs and Symptoms
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Time of arrest
Medical history
Medications
Possibility of foreign body
Hypothermia
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Unresponsive
Cardiac arrest
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Criteria for Death / No Resuscitation
Review DNR / MOST Form
YES
Do not begin
resuscitation
Respiratory failure
Foreign body, Secretions, Infection
(croup, epiglotitis)
Hypovolemia (dehydration)
Congenital heart disease
Trauma
Tension pneumothorax, cardiac tamponade,
pulmonary embolism
Hypothermia
Toxin or medication
Electrolyte abnormalities (Glucose, K)
Acidosis
NO
Follow
Deceased Subjects
Policy
Newly Born / ≤ 31 days old
YES
Exit to
Newly Born Protocol
YES
Exit to
Adult Cardiac Arrest
Protocol
NO
≥ 16 years old
AT ANY TIME
Begin Continuous CPR Compressions
Push Hard (1.5 inches Infant / 2 inches in
Children) Push Fast (≥ 100 / min)
Change Compressors every 2 minutes
(Limit changes / pulses checks ≤ 10 seconds)
Go to
Post Resuscitation
Protocol
Defibrillation Automated
if available
NO
NO
YES
ALS Available
YES
Shockable Rhythm
Shockable Rhythm
Continue CPR
5 Cycles / 2 Minutes
Repeat and reassess
Pediatric Airway
Protocol(s)
NO
YES
Follow
Pediatric
Asystole / PEA
Pediatric Airway
Protocols
Follow
Pediatric
VF / VT
Pediatric Tachycardia
Pediatric Airway
Protocols
Defibrillation Automated
Continue CPR
5 Cycles / 2 Minutes
Repeat and reassess
Pediatric Airway
Protocol(s)
Notify Destination or
Contact Medical Control
Revised
12/13/2012
Protocol 51
Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS
Pediatric Cardiac Section Protocols
NO
Return of
Spontaneous
Circulation
Pediatric Pulseless Arrest
Pediatric Cardiac Section Protocols
Pearls
· Recommended Exam: Mental Status
· Efforts should be directed at high quality and continuous compressions with limited interruptions and early
defibrillation when indicated. Compress ≥ 1/3 anterior-posterior diameter of chest, in infants 1.5 inches and
in children 2 inches. Consider early IO placement if available and / or difficult IV access anticipated.
· DO NOT HYPERVENTILATE: If no advanced airway (BIAD, ETT) compressions to ventilations are 30:2. If
advanced airway in place ventilate 8 – 10 breaths per minute with continuous, uninterrupted compressions.
· Do not interrupt compressions to place endotracheal tube. Consider BIAD first to limit interruptions.
· Airway is a more important intervention in pediatric arrests. This should be accomplished quickly with BVM or
supraglottic device. Patient survival is often dependent on proper ventilation and oxygenation / Airway Interventions.
· Success is based on proper planning and execution. Procedures require space and patient access. Make room to
work. Consider Team Focused Approach assigning responders to predetermined tasks.
· Team Focused Approach / Pit-Crew Approach. Refer to optional protocol or development of local agency protocol.
· Reassess and document endotracheal tube placement and EtCO2 frequently, after every move, and at transfer of
care.
· Monophasic and Biphasic waveform defibrillators should use the same energy levels 2 joules / kg and increase to 4
joules / kg on subsequent shocks.
· In order to be successful in pediatric arrests, a cause must be identified and corrected.
Revised
12/13/2012
Protocol 51
Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS