Pediatric Cardiac Arrest Algorithm i Mae ee ee eed G Start CPR + Begin bag-mesk ventilation and give oxygen * Attach monitor/defibrilator + IiOaccess CPR2min + Epinephrine every 3-5 min + Consider advanced airway and capnography + Epinephrine every 3-5 min + Consider advanced airway CPR2min + Amiodarone or lidocaine + Treat reversible causes @——__* + 7+ ifnosigns of return of spontaneous Cieaton OSC), goto 10 + ItROSC, go to Post Cardiac Arest Carecheckist CPR2 min ‘Teatreversible causes feans2” | of Pediatrics ‘American Academy @ Enon ‘+ Push hard (2 of anteroposterior slameter of chest) and fast {100120/min) andaitow complete chest recoll + Minimize interruptions in compressions + Change compressor every 2 minutes, or sooner fatigued + Hfnoadvancedairway, 152 compression-vontilation ratio + Hfadvanced airway, provide continuous compressions and ‘ive abreath every 2-3 seconds Breanne + First shock 2 Jka + Second shock 4 Jk + Subsequent shocks 24 Jk, maximum 10.kgeradultose | + Epinephrine 1V/10 dos ‘O01 maykg (0.1 mL/kg of the (0.1 mgiml concentration Max dose 1m. Repeat every 3-5 minutes, WnoIvio acease, may give ‘endotracheal dose: 0. ma/kg {0 mL/kgof the t mg/mL ‘concentration, + Amiodarone IVN0 dose: Smgfkg bolus during cardiac artest- May repeat up to 3 otal doses for refractory \Vefpulseless VT Lidocaine vio dost | Inti 1 mati loa ens + Endotracheal intubation or supraglottic advancedairway + Waveform capnography or ‘eapnomatry fo confirm and monitor ET tube placement es Hypovolemia Hypoxia Hydrogenion acidosis) Hypoalycemia Hypo-Inyperkalemia + Hypothermia + Tension pneumothorax * Tamponade, cardiac rhrombosis, pulmonary || = Thrombosis, coronaryPediatric Bradycardia ‘amerean | American Academy & Heart of Pediatrics With a Pulse Algorithm Aavacietons| | escemssedlakte wis Sumce [trl eue eas Cardiopulmonary ‘compromise? “+ Acutelyaltered mental status + Signs of shock = Hypotension Assessmentand support + Maintain patentairway ssistbreathing with postive ‘Start CPR THR <6OVmin despite oxygenation and ventilation. persists? + Continue CPRIF HR <60/min + IWiiO access EpinophrineIV/IO dose: 0.01 mg/kg (0.4 mLkgof te (0.1 mgm concentration, Repeat every 3-5 minutes. | IiviiOaccessnotavalsbie | butendotracneal(eritube | Inplace, may give ET dose: (Olt mg/kg 04 mLrkg ofthe ‘Vmngiml-coneantration) [Atropine W/1O dose: (0.02ma/kg.May repeat once. Minimum dase 0.1 mg and ‘maximum single dose 0.6 mg, ed * Hypothermia . + Hypoxia ( _ GotoPediatric + Medications | Gardiae Arrest Algorithm. (22020 Amecan Haart AssocationPediatric Tachycardia ‘amerean | American Acaderay cc) With a Pulse Algorithm Hee anon, | Src cactee acme Miner eu ed Initial assessment and support eed Maintain patent airway; assist breathing as necessary i ‘Synchronized cardioversion Beginwith 0.51 Jka: ifnot effective, increase to2 Jig. Sedate it needed, but don't delay cardioversion Drug Therapy Probable sinus ‘tachycardia if + Pwaves presentinormal 1 Vale Rina ‘Adenosine IV/IO dose = Fistdose:01 malig rapid balus (maximum ma) + Second dose: (0.2 mafkg rapid bolus (maximum second dose: 12mg) Evaluate rhythm with T2-lead ECG ‘or monitor. Cardiopulmonary ‘compromise? + Acutelyaltered ‘mental status * Signs of shock + Hypotension (20.09 sec) “py, (0.08 sec) QRS duration, Probable supraventricular tachycardia + Pwaves absent/abnormal + RRintervalnot variable Probable supraventricular Possible ventricular ‘tachycardia + Pwavesabsent/abnormal + BRintrval not variable 20.5118 ot) 1S6N978--61660-781-5 10/20 @.2020AmercanHeart Associaton PrntedintheUISAPediatric Septic american | American Academy Shock Algorithm (re |PRaee do Pima ee ond G a Pee ) eee eee ea erate eames greta + Mecitmtatraniee ies consonypneeda ae ceiiee Initia stabilization sooximetry. < sltonalabo sus nn ee nando aorta or 4 Do signs of shock persist after 40-60 mLikg total fud administration o evidence of id overioad? Initial stabieation oh cota vanou andar pressure monitoring ae eh eleven sett bo tray radon ra oy. Cao.sh Cong iro po part frhemaca supa oped an nena cept dc 207 vata ton te Amotean Cage Cite niche Sete SB a0 8 Koos OR Seo de ce eran Galop ies Gare -pudae ented cpa gushes management ‘edo nner cope sar enence tote onergesy xte can Ped ery ar 0106 1887208, (©2020 American Heart AssociatonManagement of Shock After ROSC Algorithm diatric Advanced Life Suppo! Optimize Ventilation and Oxygenation _ + Titrate Fio, to maintain oxyhemoglobin saturation 94%-99% _ [oF as appropriate tothe patients condition): f possible, wean FIO; atu %. Assess for and Possible ) ‘Treat Persistent Shock Contributing Factors + Identify and treat contributing Hypovolemia | factors. Hypoxia | * Consider 20 mL/kg IV/IO boluses Hydrogen ion (acidosis) | of isotonic crystalloid. Consider Hypoglycemia | smal boluses eg, 10mg) Hypo-Mhyperkalemia | s Hypothermia Tension pneumothorax Tamponade, cardiac Toxins Thrombosis, pulmonary Thrombos! Trauma coronary * Monitor for and treat agitation and seizures. * Monitor for and treat hypoglycemia. * Assess blood gas, serum electrolytes, and calcium. “ahienone can cause hypotension, suse and ination of shoul gnaralybereservedtor those txoeriencedwithite ue. intiation and sie effects (6, ICV personne ‘American Academy of Pediatrics Estimation of Maintenance Fluid Requirements + Infants <10kg: 4 mL/kg per hour Example:For an 8-kg infant, estimated maintenance fluidrate mLikg perhour8kg }2ml perhour * Children 10-20 kg: 4 mL/kg per hour for the first 10 kg + 2 mL/kg per hour for each kg above 104g, Example:For a 18-kg child, estimated maintenance fluidrate (4mLikg per hour « 10kg) + (2mL/kg perhour x5 kg) }OmLfhour + 10 mL fhour =50mL/hour + Children >20 kg: 4 mL/kg per hour for the first 10kg + 2mL/kg per hour for 111-20kg + 1 mL/kg per hour for each kg above 20kg. ‘Example:For a 28-kg child, estimated maintenance fluid rate (4 mL/kg per hour « 10 kg) +(2mLikg per hour « 10 kg) + (1 mL/kg per hour x8 kg) }OmL per hour + 20 mL per hour +8mL perhour 38 mL per hour After initial stabilization, adjust the rate ‘and composition of intravenous fluids ‘based on the patient's clinical condition and state of hydration. In general, provide ‘continuous infusion of a dextrose- containing solution for infants. Avoid hypotonic solutions in critically il children; {for most patients use isotonic fluid such asnormal saline (0.9% NaC) orlactated Ringer's solution with or without dextrose, based on the child's clinical status.foarte” | of Pediatrics Length-Based Resuscitation Tape ASSetiation. | some Pediatric Color-Coded i ‘American Academy € Abbreviations: ETT, endotracheal tube; F, French; LMA, laryngeal mask airway; NPA, nasopharyngeal airway; OPA, oropharyngeal airway; Ped, pediatric. The Broselow-Luten System Point of Care Guide is © 2020 Vyaire Medical, Inc. used with permission, Eo. ss |) = ETT cuffed (mm) 3.0 3.0 3.0 3.0 3.0 35 40 [45 | 50 55 60 ‘Suction (F) 8 8 8 8 8 8 | 10 10 10 10 | 12 OPA (mm) 50 50 50 50 50 60 60 60 70 80 80 | ssrmatagce [oso [uno [aw fawn [ass fawn [oss | sor | reno [sono | woo | (©2020 American Heart AssocationPALS Systematic American Appa Acdeny SY -~ Approach Algorithm AeSiation. | Snr : iin ans Initial assessment No normal breathing, pulse not felt Does child have severe ‘compromise of airway, breathing, or perfusion? + Support A-B-Cs. mister Is pulse <60/min with poor perfusion despite oxygenation ‘and ventilation? Arrest Algorithm,Components of american | Ammerican Academy @ Post-Cardiac Arrest Care Be ton, | eS nose ite Peter ens ‘Oxygenation and ventilation Check Measure oxygenation and target normoxemia 94%-99% (or chila's normal/appropriate oxygen saturation). | _O Measure and target Paco, appropriate to the patient's underlying condition 5 ‘and limit exposure to severe hypercapnia or hypocapnia, Hemodynamic monitoring ‘Set specific hemodynamic goals during post-cardiac arrest care and review daily. Monitor with cardiac telemetry. Monitor arterial blood pressure. Monitor serum lactate, urine output, and central venous oxygen saturation to help guide therapies. Use parenteral fluid bolus with or without inotropes or vasopressors to maintain a systolic blood pressure greater than the fifth percentile for age and sex. a jojojaja Targeted temperature management (TM) ‘Measure and continuously monitor core temperature. Prevent and treat fever immediately after arrest and during rewarming, If patient is comatose apply TTM (32°C-34C) followed by (36°C-37.5°C) or only TTM (36°C-37.5°C) Prevent shivering ojojojoja Monitor blood pressure and treat hypotension during rewarming, Neuromonitoring a IF patient has encephalopathy and resources are available, monitor with continuous electroencephalogram. ‘Treat seizures. a Consider early brain imaging to diagnose treatable causes of cardiac arrest. a Electrolytes and glucose ‘Measure blood glucose and avoid hypoglycemia. a Maintain electrolytes within normal ranges to avoid possible life-threatening arrhythmias. a Sedation ‘Treat with sedatives and anxiotytics. o Prognosis ‘Always consider multiple modalities (clinical and other) over any single predictive factor. Remember that assessments may be modified by TTM or induced hypothermia. ojojo ‘Consider electroencephalogram in conjunction with other factors within the first7 days after cardiac arrest. Consider neuroimaging such as magnetic resonance imaging during the first 7 days. o (©2020AmercanHesr Associaton