Pediatric Pulseless Ventricular Tachycardia (VT) and Ventricular Fibrillation (VF)

The effectiveness of PALS is dependent on high-quality CPR

·         Adequate compression rate (at least 100 compressions/min)

·         Adequate compression depth (at least one third of the AP diameter of the chest or approximately

·         1 1⁄2 inches [4 cm] in infants and approximately 2 inches [5 cm] in children)

·         Allowing complete recoil of the chest after each compression

·         Minimizing interruptions in compression

·         Avoiding excessive ventilation

Defibrillation

·         Primary treatment of pulseless VF/VT

·         Sudden depolarization of myocardial cells long enough for myocardial pacemaker to resume

·         Does not “jump start” the heart

Note:  If 1 shock fails to eliminate VF, the incremental benefit of another shock is low, and resumption of CPR is likely to confer a greater value than another shock. CPR may provide some coronary perfusion with oxygen and substrate delivery, increasing the likelihood of defibrillation with a subsequent shock. It is important to minimize the time between any interruption in chest compressions and shock delivery and between shock delivery and resumption of postshock compressions

Paddle Size

·          “Adult” size (8 to 13cm) for children ≥10 kg (≥ approximately 1 year)

·         “Infant” size for infants ˂ 10 kg

Paddle Placement

·         Avoids pacemakers and ICDs

·         Avoid medication patches

·         Avoid letting paddles touch

·         Apex-anterior position

·         Anterior-posterior position

Transthoracic Resistance

·         Energy level

·         Electrode size

·         Number and times between shocks

·         Distance between electrodes

·         Electrode contact pressure

·         Use of conduction gels

Note:  Small paddles should be used on infants up to one year of age and less than 10kg

Adult paddles may be used on patients older than one year and weighing over 10kg

Skin acts as a resistor that raises impedance. Using a conduction gel lowers the impedance

When shocks are delivered in a rapid sequence, the transthoracic resistance decreases and the current delivered to the heart increases

Defibrillation Safety

·         One- I’m clear

·         Two- You are clear

·         Three- Oxygen is clear

·         Four- Everybody’s clear

Note:  Defibrillation can be potentially dangerous to the operator and others who might come in contact with the patient or come in contact with the electric current