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Respond to Cardiac Arrest

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The first management step in cardiac arrest is to begin HIGH-QUALITY CPR. (See BLS section of this Handbook for details.)

Pediatric Cardiac Arrest Algorithm


CPR Quality

  • Rate at least 100 compressions per minute
  • Compression depth: 1/3 diameter of chest
  • Minimize interruptions
  • DO NOT over-ventilate
  • Rotate compressor every 2 minutes
  • If no advanced airway, 15:2 compression ventilation ratio
  • If advanced airway, 8-10 breaths per minute with continuous chest compressions

Shock Energy

  • First shock 2 J/kg
  • Second shock 4 J/kg
  • Subsequent shocks ?4 J/kg
  • Maximum 10 J/kg or adult dose

Return of Spontaneous Circulation

  • Return of pulse and blood pressure
  • Spontaneous arterial pressure waves with intra-arterial monitoring

Advanced Airway

  • Supraglottic advanced airway or endotracheal intubation
  • Waveform capnography to confirm and monitor ET tube placement
  • Once advanced airway in place, give 1 breath every 6-8 seconds (8-10 breaths per minute)

Drug Therapy

  • Epinephrine IV/IO Dose: 0.01 mg/kg. Repeat every 3-5 minutes. If no IO/IV access, may give endotracheal dose: 0.1 mg/kg
  • Amiodarone IV/IO Dose: 5 mg/kg bolus during cardiac arrest. May repeat up to 2 times for refractory VF/pulseless VT

Reversible Causes

  • Hypovolemia
  • Hypoxia
  • H+ (acidosis)
  • Hypothermia
  • Hypo-/hyperkalemia
  • Tamponade, cardiac
  • Toxins
  • Tension pneumothorax
  • Thrombosis, pulmonary
  • Thrombosis, coronary
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