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

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 intravenous medications can be administered intraosseously

·         Onset of action and drug levels are comparable to venous administration

·         IO access can be used to obtain blood samples for analysis

·         Use manual pressure or an infusion pump to administer viscous drugs or rapid fluid boluses

·         Follow each medication with a saline flush

Peripheral IVs
·         Placement may be difficult in a critically ill child
·         Give the drug by bolus injection
·         Give the drug during chest compressions
·         Follow drug with 5ml flush of NS

Endotracheal Drug Administration

·         Lipid-soluble drugs, such as lidocaine, epinephrine, atropine, and naloxone (mnemonic “LEAN”)

·         Effects may not be uniform with tracheal as compared with intravenous administration

·         Expert consensus recommends doubling or tripling the dose of lidocaine, atropine or naloxone

·         Epinephrine 0.1 mg/kg or 0.1 mL/kg of 1:1000 concentration is recommended

ET tube Medication Administration

·         Dilute the dose in 2 to 5 mL saline

·         Remove ambu bag from ET tube

·         Inject it into the ET tube

·         Replace ambu bag on ET tube

·         Administer 2 to 3 breaths with the ambu bag

Central IV Drug Delivery

•                    Peak drug concentrations are higher and drug circulation times shorter

•                    Central line placement can interrupt CPR.

•                    A central line extending into the superior vena cava can be used to monitor ScvO2 and estimate CPP during CPR, both of which are predictive of ROSC

Drug Therapy

·         Epinephrine 0.01mg/kg (0.1ml/kg of a 1:10,100 solution) IV or IO

·         Amiodarone 5mg/kg rapid IV/IO

·         Lidocaine 1mg/kg rapid IV/IO bolus

·         Magnesium 25-50mg/kg IV/IO

·         Sodium Bicarbonate 1mEq/kg IV/IO