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CARDIAC ARREST

RECOGNIZE


Unlike cardiac arrest in adults, which is very commonly due to acute coronary syndrome, cardiac arrest in pediatric patients is more commonly the consequence of respiratory failure or shock. Thus, cardiac arrest can often be avoided if respiratory failure or shock is successfully managed. Less than 10% of the time, cardiac arrest is the consequence of ventricular arrhythmia and occurs suddenly.

It may be possible to identify a reversible cause of cardiac arrest and treat it quickly. The reversible causes are essentially the same in infants and children as they are in adults.

REVERSIBLE CAUSES OF CARDIAC ARREST

THE H'S THE T'S
Hypovolemia Tension pneumothorax
Hypoxia Tamponade
H+ (acidosis) Toxins
Hypo/Hyperkalemia Thrombosis (coronary)
Hypoglycemia Thrombosis (pulmonary)
Hypothermia Trauma (unrecognized)
RECOGNIZE CARDIOPULMONARY FAILURE
AIRWAY
  • May or may not be patent
BREATHING
  • Slow breathing
  • Ineffective breathing
CIRCULATION
  • Bradycardia and hypotension
  • Slow capillary refill
  • Weak central pulses (carotid)
  • No peripheral pulses (radial)
  • Skin mottling/cyanosis/coolness
DISABILITY
  • Decreased level of consciousness
EXPOSURE
  • Bleeding?
  • Hypothermia?
  • Trauma?

RECOGNIZE ARREST RHYTHMS

ASYSTOLE

PULSELESS ELECTRICAL ACTIVITY (PEA)

VENTRICULAR FIBRILLATION (VFiB)

PULSELESS VENTRICULAR TACHYCARDIA (VTach)

PULSELESS ELECTRICAL ACTIVITY AND ASYSTOLE


Pulseless electrical activity (PEA) and asystole are related cardiac rhythms in that they are both life threatening and NOT shockable. Asystole is the absence of electrical or mechanical cardiac activity and is represented by a flat-line ECG. There may be subtle movement away from baseline (drifting flat-line) but there is no perceptible cardiac electrical activity. Make sure that a reading of asystole is not a technical error. Ensure the cardiac leads are connected, gain is set appropriately, and the power is on. Check two different leads to confirm. Pulseless electrical activity is one of any number of ECG waveforms (even sinus rhythm), but without a detectable pulse. Pulseless electrical activity may include any pulseless waveform except VFib, VTach, or asystole. Asystole may be preceded by an agonal rhythm. An agonal rhythm is a waveform that is roughly similar to a normal waveform, but occurs intermittently, slowly, and without a pulse.

PEA and asystole are NOT shockable rhythms.

VENTRICULAR FIBRILLATION AND PULSELESS VENTRICULAR TACHYCARDIA


Ventricular fibrillation (VFib) and pulseless ventricular tachycardia (VTach) are life threatening cardiac rhythms that result in ineffective ventricular contractions. VFib is a rapid quivering of the ventricles instead of a forceful contraction. The ventricular motion of VFib is not synchronized with atrial contractions. Pulseless VTach occurs when the rapidly contracting ventricles are not pumping blood sufficiently to create a palpable pulse. In both VFib and pulseless VTach, patients are not receiving adequate perfusion. VFib and pulseless VTach ARE shockable rhythms.

VFib and pulseless VTach ARE shockable rhythms.