JOE JONES NREMT-PARAMEDIC

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JOE JONESNREMT-PARAMEDIC

• PEDIATRIC ADVANCED LIFE SUPPORT

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PEDIATRIC CPR

• Establish Unresponsiveness
• Open Airway
• Breathing Look, Listen, Feel Absent Begin
  Ventilations,
• 2 breaths.
• Check pulse Absent Begin Compressions
• 30 Compressions 2 Ventilations, continue for 2
  minutes or 5 cycles.
• Call for AED child gt 1 year old/Cardiac Monitor
  check rhythm treat according to proper algorithm.
• Do not interrupt CPR for any extended period of
  time continue to compress and ventilate. Child
  age is considered to be from
• 1 8 y/o.

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CPR CONTINUED

• When this is a single rescuer attempt,
  compression ratio is
• 30 -2
• When there are two rescuers then deliver
  compressions at a rate of 15 2
• This applies to infants and children.
• Note When patient is intubated one should
  deliver ventilations 12 20 times/minute or one
  every 6 8 seconds.
•  
•  

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PEDIATRIC ADVANCED LIFE SUPPORT

• CARDIAC ARREST SCENARIO
• You arrive to find a 5 year old male in your
  trauma room who was brought in by the mother
  stating he has not been acting right for the past
  3 days. She GIVES YOU A HX OF ASTHMA AND
  PREMATURE BIRTH. THE CHILD IS NOTED TO BE WHAT
  APPEARS TO BE UNDER WEIGHT FOR HIS AGE. Mother
  states she has not been able to get him in to see
  M.D. due to the lack in her arms, there is no
  signs of trauma, you must act quickly..

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Pediatric rhythm disturbances

• Airway open
• Breathing absent
• Circulation absent
• What do we do now?
• Begin CPR 30 compressions to 2 ventilations
• Call for the monitor, doctor and all other
  appropriate personnel.
• When Monitor/AED arrive at bed side, connect,
  check rhythm and treat according to the PALS
  recommendations.

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VENTRICULAR FIBRILLATIONPULSELESS VENTRICULAR
TACHYCARDIA

• Monitor Attached, CPR stopped, MONITOR REVEAL
  RHYTHM ABOVE
• DEFIBRILLATE AT 2 JOULES PER KG. CONT. CPR 30 2
• IV/IO IN PLACE BEGIN MEDICATIONS.
• EPINEPHRINE .01 ML. KG 1-10,000
• CPR is Continued for two minutes and
• DEFIBRILLATE 4 JOULES PER KG. CONTINUE CPR
• AMIODARONE 5 MG. KG.
• LIDOCAINE 0.5 1 MG/KG
• MOST SKILLED PERSON INTUBATE THE TRACHEA, CONFIRM
  PLACEMENT USING END TITAL CO2, BBS, GOOD
  RISE-FALL CHEST, COMPLETE CPR, CONFIRM RHYTHM
  THEN
• COMPLETE CPR CYCLE AND DEFIBRILLATE 4 JOULES KG.
• EPINEPHRINE .01MG KG REPEAT 3 5 MINUTES
• CORDARONE 5 MG. KG. or LIDOCAINE repeated max 3
  mg. kg.
• Note If Torsades is present, administer mag.
  Sulfate 25 50 mg. kg. epi .01 mg. kg. repeat 3
  5 min.

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ASYSTOLE/PEA

• CPR UNTIL MONITOR IS AVAILABLE THEN CONFIRM
  RHYTHM ABOVE CONTINUE CPR 30 2
• INITIATE IV/IO AND ADMINISTER EPINEPHRINE .01 MG
  KG (NOTE) USE BROSELOW TAPE
• INTUBATE/CONFIRM PLACEMENT
• NOTE ONCE CORRECT PLACEMENT OF THE TUBE IS
  VERIFIED, THEN ONE DOES NOT NEED TO STOP
  COMPRESSIONS
• EPINEPHRINE .01 MG/ KG
• REPEAT 3-5 MIN. AT .01MG KG
• ATROPINE ?????? WHY ____ USE ONLY IF A CARDIAC
  EVENT IS SUSPECTED
• CONSIDER CAUSES TREAT APPROPRIATELY
• EXAMPLE HYPOXIA, ACIDOSIS, HYPOVOLEMIA,
  ELECTROLYTE IMBALANCE.

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UNSTABLE TACHYCARDIA

• Remember a child is not considered to be in
  supraventricular
• tachycardia until the rate is gt 180 beats per
  minute, Infants
• greater than 220. Rule out causes prior to
  beginning
• cardiac treatment!!  
• Primary A-B-Cs Support that Airway
• Administer Oxygen
• Serious signs and symptoms present
• Synchronize Cardiovert at .5 - 1 joule kg.
• Synchronize Cardiovert at 2 joules kg.
• Move to medications. (REFER TO STABLE
  TACHYCARDIA
• FOR CORRECT MEDS AND DOSING).
• Remember support the airway.

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SVT STABLE

• Primary A-B-Cs Administer oxygen
• Vagal maneuvers blow in closed straw, ice water
  to face
• IV IO in place
• Adenosine .01 mg. kg. not to exceed 6 mg.
  repeat
• 3 5 minutes
• Adenosine. 02 mg. kg not to exceed 12 mg.
• Adenosine .02 mg. kg. not to exceed 12 mg.
•  After Adenosine it will be M.D. choice follow
  orders.
• MAY CONSIDER BETA BLOCKER/CALCIUM CHANNEL
  BLOCKERS OR CARDIOVERSION.

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VENTRICULAR TACHYCARDIASTABLE

• V Tach
• Primary A-B-Cs Administer oxygen
• IV IO in place
• Amiodarone 5 mg. - kg. repeat in 5 10 minutes
• Procainamide 15mg/kg IV over 30 60 minutes. Do
  not administer Amiodarone and Procainamide
  together.
• Lidocaine may be used when Amiodarone is not
  available
• Remember do not rely on memory for drug doses,
  rely on Broslow Tape

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BRADYCARDIA

• Primary A-B-Cs Administer oxygen.
• Remember Bradycardia in children is usually
  caused by hypoxia, dont delay the administration
  of this DRUG
• IV IO in place
• Epinephrine drug of choice. Use broslow tape for
  correct dose, never rely on memory for correct
  dose of medications in peds.
• Atropine???????? Primary cause is
  __________________? If the provider believes the
  cause of the bradycardia is from a Vagal response
  then Atropine would be the first drug of choice
  after oxygen.
• Dose is .02 mg. kg. never give less than .1mg.
  Be sure to administer the medication rapid IVP.

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SHOCK

• The most common cause of shock in a child is
  hypovolemia. This can come from several causes.
  Nausea/Vomiting, Bleeding, etc. The treatment of
  choice is fluids. Shock is defined as Inadequate
  Tissue Perfusion and is deadly if not corrected.
  It may be identified as Compensated or
  Decompensated shock. The difference in these two
  terms are Decompensated is when the blood
  pressure falls. Remember in children when the
  blood pressure begins to fall it happens quick so
  dont wait for this symptom to occur.

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TREATMENT OF SHOCK CONTINUED

• Primary A-B-Cs
• Administer oxygen high flow
• IV IO
• Prior to the IO one should make 3 peripheral
  attempts or 90 seconds
• IO placed 2 cm. below tibial tuberosity medical
  side of the leg. It is confirmed in correct
  place when fluids and medications flow freely
  without signs of local tissue swelling.
• Administer now 20 ml. kg. then reassess
  patient.
• This may be repeated times 4 for a total of 80
  ml-kg. in severe cases.

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Pediatric shock Continued!!

• Pump problems are treated according to rhythms.
  Slow heart, speed up. Fast hearts, slow down. Do
  not overload your patient. One may choose to use
  a Vasopressor drug in this case.
• Examples of these drugs are
• Dopamine Dobutamine Norepinephrine,
  Epinephrine . Milrinone may be used in the case
  of CHF for its classified as an inotropic
  medication.

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Pediatric shock CONTINUED

• Rely on the Broslow tape for correct doses never
  rely on memory.
• Hypovolemic shock, non-hemorrhagic shock should
  be treated with fluids 20 ml./kg. reassess total
  up to 4 boluses. Hemorrhagic shock initial with
  fluids then PRBCs 10 ml./kg or whole blood 20
  ml/kg. To prevent adverse reactions one should
  warm prior to administration of blood.
• Septic shock fluids then consider ordering
  vasopressor along with hydrocortisone.
  Normotensive patient use dopamine
• Hypotensive patient warm shock vasodilated begin
  norepinephrine.
• Hypotensive patient cold shock vasoconstricted
  use epinephrine rather than norepinephrine.

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RESPIRATORY SCENARIO

• You arrive in your trauma area and find a young
  mother holding a 3 year-old child in her arms.
  The child is in, what appears to be, extreme
  distress. She gives you a history of cold like
  symptoms over the past 2 4 days and unable to
  get him any better. She also advises you that
  the child has been experiencing asthma since he
  was 18 months old.
• Physical Exam Conscious, pale and crying with
  ventilations of greater than 50 minute. There is
  noted wheezes to all lung fields. What should
  you do for this patient?

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RESPIRATORY TREATMENT

• AIRWAY, BREATHING, CIRULATION
• OXYGEN
• BETA AGONIST MEDICATION VIA NEBULIZER
• IV
• CHEST X-RAY
• CONSIDER STEROIDS
• ADMIT FOR DEFINITIVE TREATMENT