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

Energy Dose

·         Initial monophasic dose of 2 J/kg is effective in terminating VF 18% to 50% of the time

·         Biphasic shocks are effective 48% of the time

·         It is acceptable to use an initial dose of 2 to 4 J/kg

·         For refractory VF, it is reasonable to increase the dose to 4 J/kg

·         Subsequent energy levels should be at least 4 J/kg, and higher energy levels may be considered, not to exceed 10 J/kg or the adult maximum dose

Primary Survey

·         Assess patient

·         Support CABs

·         CPR

·         Attach defibrillator/monitor

·         Assess rhythm

Note:  CABs- Compressions-Airway-Breathing

Check the patient for responsiveness and presence/absence of breathing or gasping.

Call for help, activate emergency response system, and get AED/defibrillator.

Check for pulse for no more than 10 seconds.

Give 30 compressions.  The depth of each compression should be approximately 2 inches in children and 1.5 inches in infants

Open the airway and give 2 breaths.

Resume compressions at a rate of at least 100/min

Pulseless VF/VT

·         Begin CPR

·         Call for defibrillator/monitor or AED

·         Defibrillate at 2J-4J/kg

·         Continue CPR for 5 cycles

·         Recheck pulse and reevaluate rhythm

Note:  Treatment for a child who has ventricular fibrillation or pulseless ventricular tachycardia involves stabilization of C, A,Bs (Chest compressions Airway management, and breathing with bag-mask ventilation and oxygen) followed by ECG monitoring. The most important treatment of  VF or pulseless VT is immediately defibrillation. If the dysrhythmia persists, obtain vascular access and administer epinephrine followed by defibrillation. If there is no response, administer amiodarone or lidocaine, continuing defibrillation attempts alternately with medication administration. If torsade de pointes or hypomagnesemia is present, administer magnesium.

Secondary Survey

·         Intubate

·         Oxygenate

·         IV/IO access

·         Treat reversible causes

Note: Once the patient is intubated, continue CPR with asynchronous ventilations and chest compressions.

Formula for Estimating Endotracheal tube size: 

Uncuffed ET tube:  mm ID = (age in years/4) + 4

Cuffed ET tube:  mm ID = (age in years/4) + 3

Confirm ET tube placement

n ·         Direct cord visualization

·         End-tidal CO2 monitor

  Purple- problem

  Yellow- yes

  Tan- think about it

·         Bilateral breath sounds

·         CXR

·         Continuous waveform capnography

Note:  Continuous quantitative waveform capnography is now recommended for intubated patients throughout the periarrest period as a means of both confirming and monitoring correct placement of an endotracheal tube.