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Stable patient ·          Observe ·          Support ABCs ·          Reassess patient for symptoms of cardiac compromise Note:  Reassess the patient to determine if bradycardia is still causing cardiorespiratory symptoms despite support of adequate oxygenation and ventilation Unstable patient ·          Perform chest compression ·          Heart rate < 60/min in infant or child with poor systemic perfusion despite oxygenation Note:  Revaluate the patient for signs of compromised cardiac output, including reduced responsiveness, weak central pulses, weak or absent peripheral pulses, hypotension, delayed capillary refill, and cool extremities. Drug Management ·          Epinephrine ·          Atr...

Primary Causes ·          Heart blocks (congenital heart disease) ·          Heart transplants (vagal denervation) ·          Cardiomyopathies ·          Myocarditis ·          Surgical injury to pacemaker or conduction system Secondary Causes ·          Hypoxemia ·          Hypothermia ·          Hypothermia ·          Head injury ·          Acidosis ·          Toxins- Digoxin, Beta Blockers, Calcium channel blockers ·          May be induced by excessive vagal stimulation from suctioning or intubation Managemen...

Bradyarrhythmia ·          Heart rate less than 60 ·          Significant when accompanied by hypotension ·          Most common pre-arrest arrhythmia in pediatric patients ·          Often associated with hypoxemia, hypotension, and acidosis Note:  Bradycardia, which is defined by a heart rate slower than 60 beats per minute, usually arises secondary to hypoxemia from airway compromise or ineffective respiration. The rhythm is usually sinus or junctional, but AV block may arise in the terminal phase. Slow Rhythms ·          Heart Blocks ·           Bradycardia ·          Sinus Node arrest ·          Slow Junctional ·       ...

1. 2. 3. 4. 5. 6. 7. Answers 1. Sinus arrhythmia and a PAC Sinus arrhythmia  and a PAC.   The rhythm  irregular even with the PAC.  The rate is between 46 -54.   There is an upright P wave before each QRS complex. PRI: .20 sec. QRS: .08  QT: .52.  The P wave of the PAC (4th complex) is buried in the T wave of the preceding complex.  You will notice that it differs in shape and height from the other T waves of the other sinus beats.   2. Atrial bigeminy Atrial bigeminy.  The rhythm is regular except for the atrial ectopy.    The rate is 80.  There is an upright P wave for each QRS complex.  PRI: .12 sec.  QRS: .08 sec QT: .36   There are PACs every other beat which gives this a bigeminal pattern.  The P waves of the PACs are smaller than the native, sinus, P waves.   3. Atrial fibrillation with multifocal PVCs Atrial fibrillation with...

Magnesium ·          25-50mg/kg IV/IO ·          Maximum 2gm ·          Torsades de Pointes VT ·          Hypomagnesemia ·          Continue CPR for 2 minutes then defibrillate at 4J/kg Note:  Magnesium is indicated for the treatment of documented hypomagnesemia or for torsades de pointes (polymorphic VT associated with long QT interval). Magnesium produces vasodilation and may cause hypotension if administered rapidly. Sodium Bicarbonate ·          Dose 1mEq/kg IV/IO ·          For prolonged arrest interval ·          Hyperkalemia ·          Tricyclic antidepressant overdose Note:  Routine use of sodium bicarbonate duri...

Epinephrine ·          Epinephrine 0.01mg/kg (0.1ml/kg of a 1:10,100 solution) IV or IO ·          Epinephrine 0.1mg/kg (0.1ml/kg of a 1:1000 solution) via ET tube ·          May repeat dose every 3-5 minutes ·          After 5 cycles of CPR then defibrillate at 4J/kg Note:  Vasopressin, which is frequently useful in adults, is not recommended for children experiencing ventricular fibrillation or pulseless ventricular tachycardia Drug Therapy: Epinephrine ·          Increases systemic vascular resistance ·          Increases aortic root pressure ·          Increases coronary and cerebral perfusion during CPR ·          Escalating or high doses without demonstrable ...

Broweslow Tape Medication Dose Calculation ·          Use the child’s weight if it is known ·          If the child’s weight is unknown, it is reasonable to use a body length tape ·          No data regarding the safety or efficacy of adjusting the doses for obese patients IV Access ·          Peripheral IV ·          Central line ·          Intraossious ·          Intratracheal Note:  Limit the time you spend trying to obtain IV access.  If IV access cannot be achieved immediately then establish IO access.  If this is not possible then administer medications via the intratracheal route. Intraosseous (IO) Access ·          All intra...

Esophageal Detector Device (EDD) ·          May be considered in children weighing ≥ 20 kg with a perfusing rhythm ·          Insufficient data to recommend for or against its use in children during cardiac arrest When to Verify Endotracheal Tube Placement ·          Verify proper tube placement immediately after intubation ·          After securing the endotracheal tube ·          During transport ·          Each time the patient is moved (eg, from stretcher to bed) DOPE Mnemonic ·          If an intubated patient’s condition deteriorates ·          D isplacement of the tube ·           O bstruction of the tube ·   ...