Pediatric Cardiac Arrest Algorithm

Pediatric Cardiac Arrest Algorithm

Primary algorithm of PALS. Can include asystole, PEA, ventricular fibrillation, pulseless ventricular tachycardia. Includes shock energies for defibrillation, and drug dosages.

When a child is determined to be in cardiac arrest, or heart rate less than 60 with signs of poor perfusion, the following steps should be started immediately:

Step 1:  Begin CPR immediately. Begin bag-valve-mask (BVM) and give oxygen. Attach monitor / defibrillator.

Step 2:  Is rhythm shockable? Ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT).

Step 3:  Shock. First shock is 2 J/kg. Second is 4 J/kg. Maximum 10 J/kg.

Step 4:  CPR x 2 minutes. Push hard and fast (100-120 compressions / minute). Minimize interruptions. Change  compressor every 2 minutes. If no advanced airway, 15:2 compression / ventilation ratio. If advanced airway, continuous compressions, and ventilate every 2-3 seconds. Is rhythm shockable?

Step 5:  Shock. Same energy as above.

Step 6: CPR x 2 minutes. Epinephrine every 3-5 minutes (.01 mg/kg). Consider advanced airway (endotracheal tube or supraglottic airway). Is rhythm shockable?

Step 7: Shock. Same energy as above.

Step 8: CPR x 2 minutes. Amiodarone (5 mg/kg bolus) or Lidocaine (1 mg/kg). Treat reversible causes (H’s and T’s).

Step 9: Continued from branch point between step 2 and step 3. Is rhythm shockable – No. Asystole / PEA. Give epinephrine .01 mg / kg.

Step 10: CPR x 2 minutes. Obtain IV/IO access. Epinephrine every 3-5 minutes. Consider advanced airway, capnography. Is rhythm shockable. No.

Step 11: CPR x 2 minutes. Treat reversible causes (H’s and T’s). Is rhythm shockable? No.

Step 12: If no signs of return of spontaneous respiration (ROSC). Go to step 10. If ROSC, go to post cardiac arrest care. Consider appropriateness of continued resuscitation.

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